科研之友
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摘要
Isolation areas post-28-mm cryoballoon pulmonary vein isolation (CB-PVI) are smaller than post-radiofrequency PV antrum isolation at the left superior PV (LSPV) antrum and recurrent atrial fibrillation (AF) can originate from this area. This pilot study evaluated the impact of additional extra-PV CB applications at the LSPV antrum following conventional CB-PVI. Eighteen paroxysmal AF patients underwent CB-PVI with single 3-min freeze techniques. Following the CB-PVI, 2-min CB applications were added once or twice at the LSPV antrum. Before and after extra-PV ablation, left atrial (LA) 3-D electroanatomical maps were created. Seventy-two total PVs were successfully isolated with 4.2 +/- 0.4 applications/patient with 28-mm CBs. The mean LA posterior wall (LAPW) and non-isolated LAPW areas were 14.9 +/- 3.6 and 6.9 +/- 2.8 cm(2), respectively. After 1.6 +/- 0.5 mean extra-PV applications, the upper non-isolated LAPW area significantly decreased from 3.3 +/- 1.8 to 2.5 +/- 1.8 cm(2) (p < 0.001). The lowest esophageal temperatures during the extra-PV ablation were 27 A degrees C. The total procedure and fluoroscopic times were 72.8 +/- 13.1 and 15.2 +/- 5.9 min, respectively. Silent gastric hypomotility was detected in 2/9 patients 1 day later, and mild PV stenosis was observed in 4/72 PVs 3 months later, but did not progress. At 12-month after single procedures, 16 (88.9%) patients were free from recurrent AF off antiarrhythmic drugs. A median of 8.0 [6.0-10.0] months later, PV reconnections were detected in 3/12 (25.0%) PVs. The non-isolated LAPW area was significantly larger in the chronic than acute phase (14.3 +/- 5.2 cm(2), p = 0.016). This pilot study suggested the potential feasibility of additional LSPV antral cryoapplications following a conventional CB-PVI. The strategy warrants further study in more patients.
- 出版日期2018-9
