Cryoballoon temperature parameters during cryoballoon ablation predict pulmonary vein reconnection and atrial fibrillation recurrence.
Cryoballoon temperature parameters during cryoballoon ablation predict pulmonary vein reconnection and atrial fibrillation recurrence.
复制标题
冷冻球囊消融期间的冷冻球囊温度参数可预测肺静脉重新连接和心房颤动复发。
DOI：
10.1007/s10840-022-01429-0
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Akoum,Nazem
中科院分区：
文献类型：
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作者：
Chahine,Yaacoub;Afroze,Tanzina;Bifulco,SavannahF;Macheret,Fima;Abdulsalam,Nashwa;Boyle,PatrickM;Akoum,Nazem
背景冷冻球囊消融（CBA）是房颤（AF）节律管理的既定方法。我们试图评估球囊温度 (BT) 参数，作为指数手术中肺静脉 (PV) 重新连接和 CBA 后 AF 复发的预测因子。方法 对 119 名接受 CBA 的 AF 患者进行 BT 监测。在手术过程中对 PV 重新连接进行评估，并随访患者的心律失常复发情况。结果在 471 例 PV 中，有 39 例 (8.3%) 发现 PV 重新连接。在没有PV重新连接的情况下，BT明显更冷（30秒： − 33.5°C [− 36; − 30] vs − 29.5°C [− 35; − 25.5]，p= 0.001；60秒： − 41°C [− 44; − 37] vs − 36.5°C [− 42; − 33.5],p< 0.001;最低点: − 47°C [− 52; − 43] vs − 41.5°C [− 47; − 38],p< 0.001)。 PV 重新连接与达到 − 15 °C 和 – 40 °C 的时间显着延长相关（14.5 s [11.5–18.5] 与 12 s [10–15.5]，p= 0.023；75 s [40–95.5] 与 46 s [37–66.75]，p= 0.005）和更短的复温时间（5.75 s [4.75–8.5] vs 7 s [6–9]，p= 0.012）。这些程序参数的 ROC 分析在预测 PV 重新连接方面的 AUC = 0.71。 51 名 (42.8%) 患者发生房颤复发。 Kaplan-Meier 分析显示，与至少一个 PV 中 BT 未低于 – 40°C 的患者 (logrank = 6.3，p= 0.012) 和有 PV 重新连接的患者 (log等级 = 4.1,p= 0.043)。结论 BT 下降较慢、BT 最低点较暖和复温时间较快可预测 PV 早期重新连接。 CBA 期间所有 PV 中没有早期 PV 重新连接以及 BT 降至 – 40°C 以下与较低的 AF 复发率相关。
BackgroundCryoballoon ablation (CBA) is an established approach for rhythm management of atrial fibrillation (AF). We sought to assess balloon temperature (BT) parameters as predictors of pulmonary vein (PV) reconnection within the index procedure and AF recurrence following CBA.MethodsBT was monitored in 119 AF patients undergoing CBA. PVs were assessed for reconnection during the procedure and patients were followed for arrhythmia recurrence.ResultsPV reconnection was identified in 39 (8.3%) of 471 PVs. BT was significantly colder in the absence of PV reconnection (30 s: − 33.5 °C [− 36; − 30] vs − 29.5 °C [− 35; − 25.5],p= 0.001; 60 s: − 41 °C [− 44; − 37] vs − 36.5 °C [− 42; − 33.5],p< 0.001; nadir: − 47 °C [− 52; − 43] vs − 41.5 °C [− 47; − 38],p< 0.001). PV reconnection was associated with significantly longer time to reach − 15 °C and – 40 °C (14.5 s [11.5–18.5] vs 12 s [10–15.5],p= 0.023; and 75 s [40–95.5] vs 46 s [37–66.75],p= 0.005) and shorter rewarming time (5.75 s [4.75–8.5] vs 7 s [6–9],p= 0.012). ROC analysis of these procedural parameters had an AUC = 0.71 in predicting PV reconnection. AF recurrence occurred in 51 (42.8%) patients. Kaplan–Meier analysis showed better arrhythmia-free survival for patients in whom BT decreased below – 40 °C in all PVs and patients who had no early PV reconnections, compared to patients in whom BT below – 40 °C was not achieved in at least one PV (log rank = 6.3,p= 0.012) and patients who had PV reconnections (log rank = 4.1,p= 0.043).ConclusionsSlower BT decline, warmer BT nadir, and faster rewarming time predict early PV reconnection. Absence of early PV reconnections and BT dropping below – 40 °C in all PVs during CBA are associated with lower rates of AF recurrence.