Lesion formation after pulmonary vein isolation using the advance cryoballoon and the standard cryoballoon: lessons learned from late gadolinium enhancement magnetic resonance imaging
Lesion formation after pulmonary vein isolation using the advance cryoballoon and the standard cryoballoon: lessons learned from late gadolinium enhancement magnetic resonance imaging
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DOI：
10.1093/europace/euu260
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发表时间：
2015-04-01
期刊：
影响因子：
6.1
通讯作者：
Mahnkopf, Christian
中科院分区：
文献类型：
--
作者：
Halbfass, Philipp Matthias;Mitlacher, Marcel;Mahnkopf, Christian
目的比较3个月后应用标准冷冻机(CB-S)和重新设计的冷冻机北极前沿推进系统(CB-A)进行肺静脉隔离(PVI)后消融病变的形成情况。方法与结果连续36例阵发性或短暂性持续性房颤(房颤)患者在PVI后分别使用CB-S和CB-A进行前瞻性评估。所有患者在消融后3个月行LGE-MRI和7天动态心电图监测。56%的患者为男性(平均年龄63.0+/-9.1岁)。消融后3个月房颤复发率分别为56%和89%(P=0.025)。消融3个月后，LGE-MRI显示第一组35%的PVs和第二组(N.S.)32%的PVs显示完整的环形病变。左门静脉完全消融节段的比例显著高于右门静脉(83%vs.34%；P<；0.001)。结论心脏磁共振成像能够显示PVI后诱发的消融病变，可能适合于量化消融病变的数量。尽管CB-A组的房颤复发率显著低于CB-A组，但CB-S组的消融病变形成与CB-A组相比没有显著差异。左侧门静脉消融损伤量明显高于右侧门静脉。需要更大规模的随机研究来了解可代表的组织病变与成功率之间的关系。
Aims To compare ablation lesion formation after pulmonary vein isolation (PVI) using the standard cryoballoon (CB-S) vs. the re-designed cryoballoon Arctic Front Advance (CB-A) using late gadolinium enhancement magnetic resonance imaging (LGE-MRI) 3 months post-ablation.Methods and results Thirty-six consecutive patients with paroxysmal or short-lasting persistent atrial fibrillation (AF) were evaluated prospectively after PVI using the CB-S in the first 18 patients and the CB-A in the subsequent 18 patients. All patients underwent LGE-MRI and a 7-day Holter electrocardiogram monitoring 3 months after ablation. Fifty-six per cent of the patients were male (mean age 63.0 +/- 9.1 years). Fifty-six per cent in the first group and 89% in the second group were free of AF recurrence 3 months after ablation (P = 0.025). Three months after ablation, LGE-MRI of the left atrium showed complete circular lesions in 35% of PVs in the first group and in 32% of PVs in the second group (n.s.). The left PVs showed a significantly higher proportion of PV segments with complete ablation lesions compared with the right PVs (83 vs. 34%; P < 0.001).Conclusion Cardiac MRI is able to visualize induced ablation lesions after PVI and might be suitable to quantify ablation lesion amount. Ablation lesion formation did not differ significantly in patients treated with the CB-S vs. the CB-A, despite a significantly lower rate of AF recurrence after 3 months in the CB-A group. Left PVs showed a significantly higher amount of ablation lesions compared with the right PVs. Larger and randomized studies are needed to understand the relationship between representable tissue lesions and success rates.