Catheter-based cryoablation permanently cures patients with common atrial flutter
Catheter-based cryoablation permanently cures patients with common atrial flutter
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DOI：
10.1161/01.cir.0000124478.98343.00
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发表时间：
2004-04-06
期刊：
影响因子：
37.8
通讯作者：
Rodriguez, LM
中科院分区：
文献类型：
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作者：
Manusama, R;Timmermans, C;Rodriguez, LM
背景-冷冻消融（cryo）短期治疗心房扑动（AFL）成功率高，但长期疗效尚缺乏证据。本研究报道了普通AFL患者颈尖峡（CTI）冷冻的长期效果。方法和结果：连续35例患者（28例男性，平均年龄53岁）行CTI冷冻。34例患者AFL逆时针旋转（周期长度242 +/- 43 ms）。11名患者患有结构性心脏病。使用10F导管和6mm尖端电极（CryoCor）进行冷冻。应用程序（每次3至5分钟）通过使用逐点技术来创建消融线。手术的急性终点是建立双向峡部传导阻滞和AFL的非诱导性。在沿CTI的10个站点（范围4至19）进行了14次应用（范围4至30），平均温度为-80.0 +/- 5.0℃。平均透视时间和手术时间分别为40 +/- 26分钟和3.2 +/- 1.3小时。35例患者中，34例急性消融成功（97%）。平均随访17.6±6.2个月（9.6 ~ 26.1个月），31例（89%）患者无AFL复发。4例复发患者中有3例第二次手术成功。1例患者在冷冻过程中出现短暂性下导联ST段抬高。结论-低温产生永久性的峡部双向传导阻滞。短期和长期的成功率与射频消融相当。
Background - Cryoablation (cryo) has a high success rate in the short-term treatment of atrial flutter (AFL), but evidence of long-term efficacy is lacking. The present study reports the long-term effect of cryo of the cavotricuspid isthmus (CTI) in patients with common AFL.Methods and Results - Thirty-five consecutive patients (28 men; mean age, 53 years) underwent cryo of the CTI. In 34 patients, the AFL had a counterclockwise rotation (cycle length, 242 +/- 43 ms). Eleven patients had structural heart disease. Cryo was performed with a 10F catheter with a 6-mm-tip electrode (CryoCor). Applications (3 to 5 minutes each) were delivered by use of a point-by-point technique to create the ablation line. The acute end point of the procedure was creation of bidirectional isthmus conduction block and noninducibility of AFL. A median of 14 applications (range, 4 to 30) at 10 sites (range, 4 to 19) was given along the CTI with a mean temperature of -80.0 +/- 5.0degreesC. Mean fluoroscopy and procedure times were 40 +/- 26 minutes and 3.2 +/- 1.3 hours, respectively. Of the 35 patients, 34 were acutely successfully ablated (97%). After a mean follow-up of 17.6 +/- 6.2 months (range, 9.6 to 26.1 months), 31 patients (89%) did not have recurrence of AFL. Three of the 4 patients with recurrence had a second successful procedure. One patient had transient ST elevation in the inferior leads during cryoapplication.Conclusions - Cryo produces permanent bidirectional isthmus conduction block of the CTI. Short- and long-term success rates are comparable to those for radiofrequency ablation.