Differences in the electrophysiological findings of repeat ablation between patients who first underwent cryoballoon ablation and radiofrequency catheter ablation for paroxysmal atrial fibrillation
Differences in the electrophysiological findings of repeat ablation between patients who first underwent cryoballoon ablation and radiofrequency catheter ablation for paroxysmal atrial fibrillation
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DOI：
10.1111/jce.14065
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发表时间：
2019-07-25
影响因子：
2.7
通讯作者：
Hirao, Kenzo
中科院分区：
文献类型：
--
作者：
Inamura, Yukihiro;Nitta, Junichi;Hirao, Kenzo
引言几项研究表明，对于药物难治性阵发性房颤（AF）患者，基于第二代冷冻球囊（CB）的肺静脉（PV）隔离不劣于基于射频（RF）的PV隔离。然而，重复消融的电生理差异仍不清楚。方法和结果本研究检查了首次接受射频导管消融和CB消融的患者在重复消融期间的电生理差异;评估了这些患者的肺静脉耐久性和非肺静脉房颤病灶。我们入组了2013年1月至2017年6月期间在我们机构分别接受CB消融（CB组）和RF导管消融（RF组）治疗阵发性AF的919例和491例患者。使用射频消融的肺静脉隔离涉及左心房（LA）窦和部分LA后壁。2年随访后，CB组和RF组分别有62例和80例患者接受了重复消融。RF组的肺静脉再连接频率高于CB组（上级静脉：46.2%和14.5%，P < .001;左下肺静脉：35.0%和11.2%，P = .001;上级静脉：40.0%和22.6%，P = .031;右下肺静脉：36.2%和19.4%，P = .039;肺静脉：39.8%和16.9%，P <0.001）。CB组的LA AF病灶比RF组更常见（27.4%和7.5%; P = 0.002）。其他非肺静脉病灶在两组中普遍存在。结论CB消融可减少左心房-肺静脉再连接。然而，广泛的肺静脉隔离可以消除许多左心房房颤病灶。
Introduction Several studies have revealed that second-generation cryoballoon (CB)-based pulmonary vein (PV) isolation is noninferior to radiofrequency (RF)-based PV isolation for patients with drug-refractory paroxysmal atrial fibrillation (AF). However, electrophysiological differences in repeat ablation remain unclear. Methods and Results This study examined electrophysiological differences during the repeat ablation between patients who first underwent RF catheter ablation and CB ablation; PV durability and non-PV AF foci were assessed for these patients. We enrolled 919 and 491 patients who underwent CB ablation (CB group) and RF catheter ablation (RF group), respectively, for paroxysmal AF between January 2013 and June 2017 at our institution. PV isolation using RF ablation involved the left atrium (LA) antrum and part of the LA posterior wall. After 2 years of follow-up, 62 and 80 patients in the CB and RF groups, respectively, underwent repeat ablation. PV reconnections were more frequent in the RF group than in the CB group (left superior PV: 46.2% and 14.5%, P < .001; left inferior PV: 35.0% and 11.2%, P = .001; right superior PV: 40.0% and 22.6%, P = .031; right inferior PV: 36.2% and 19.4%, P = .039; PVs: 39.8% and 16.9%, P < .001). LA AF foci were more frequent in the CB group than in the RF group (27.4% and 7.5%; P = .002). Other non-PV foci were prevalent in both groups. Conclusion Fewer LA-PV reconnections occurred with CB ablation. However, extensive PV isolation may eliminate many LA AF foci.