冷冻球囊消融心房颤动术后复发患者的二次手术特点

Characteristics of redo procedures of patients after pulmonary vein isolation using cryoballoon ablation technique

目的：总结冷冻球囊导管消融术后复发的心房颤动（房颤）患者的2次手术特点，并指导对冷冻球囊导管消融术的优化。方法连续入选自2013年12月至2015年12月就诊于本研究组行冷冻球囊消融术的房颤患者，于随访中复发并行2次手术的患者10例。所有患者利用三维标测系统指导的冷盐水灌注射频消融导管进行肺静脉的再隔离，并对其他可诱发的心动过速进行消融。结果以上10例患者中持续性房颤3例，阵发性房颤7例。首次手术中所有肺静脉（41支）均成功电隔离。以上患者于首次手术后平均（4.8±2.3）个月后接受2次手术。2次手术提示总计21支（51.2％）肺静脉恢复了左心房-肺静脉传导，总计存在漏点23处，下肺静脉漏点数量显著多于上肺静脉，且集中于上下肺静脉结合部及下肺静脉的底部。以上肺静脉均于2次手术中成功补点隔离。此外2次手术中成功消融隔离上腔静脉1例，典型心房扑动（房扑）1例，二尖瓣环折返性房性心动过速（房速）1例以及房室结折返性心动过速1例。中位随访时间为5（1~19）个月，随访期间有1例患者再次复发房颤，服用抗心律失常药物后控制良好。其余9例患者于随访期间均为窦性心律。结论冷冻球囊导管消融术后复发患者在2次手术中的传导恢复部位存在一定的规律性，主要集中于双侧下肺静脉。补点消融重新隔离肺静脉是安全、有效的。

Objective To summarize the characteristics of redo procedures in patients after cryobal-loon ablation for atrial fibrillation and to provide guidance for future cryoballoon technique. Methods From December 2013 to December 2015,nine consecutive patients with prior cryoballoon ablation for atrial fibrillation and recurrent atrial tachyarrhythmia were retrospectively enrolled.All patients underwent radiofrequency irriga-tion catheter ablation guided by 3-dimentional mapping system for pulmonary vein re-isolation and other induc-ible tachycardia.The ipsilateral pulmonary vein antrum was divided into six equally distributed segments for the analysis of the location of conduction gaps. Results All the 10 patients were male with an average age of（48. 4± 10. 9） years. Three patients had persistent atrial fibrillation and 7 patients presented paroxysmal atrial fibrillation.During the prior cryoballoon ablation,all 41 pulmonary veins,including 1 common left pulmonary vein（CLPV）,9 left superior pulmonary veins（LSPV）,9 left inferior pulmonary veins（LIPV）,10 right superior pulmonary veins （ RSPV）, 10 right inferior pulmonary veins （ RIPV） and 2 right middle pulmonary veins （RMPV）, were successfully isolated using single 28 mm cryoballoon with an average of（12. 3±1. 9）cryoablation applications per one patient.These patients presented recurrent atrial tachyarrhythmia during follow-up and＆amp;nbsp;underwent redo procedures in（4. 8 ± 2. 3） months after the cryoballoon ablation. Twenty-one pulmonary veins （51. 2%）,including 1 CLPV,3 LSPV,7 LIPV,4 RSPV and 6 RIPV,exhibited reconduction during redo proce-dures.Among all the 10 patients,one patient exhibited no pulmonary vein reconduction while other patients exhibited varying numbers of pulmonary vein reconduction.The reconduction sites（23 sites in total）were more frequent in inferior pulmonary veins.All the reconducted pulmonary veins were successfully re-isolated.And ra-diofrequency ablation was applied in additional superior vena cava isolation in one patient,typical atrial flutter in one patient,peri-mitral atrial flutter in one patient and atrio ventricular nodal reentrant tachycardia in one pa-tient.During a median follow-up of 5 months,one patient presented recurrent paroxysmal atrial fibrillation which could be well controlled by anti-arrhythmia drugs.The other patients remained in sinus rhythm during follow-up. Conclusion Patients underwent prior cryoballoon ablation for pulmonary vein isolation exhibited relatively lower rate of reconduction,which presented in favored sites（i.e.inferior pulmonary veins）.Re-isolation of pul-monary veins,along with additional ablation for other triggers and tachycardia,is effective and safe for the treat-ment of recurrent atrial tachyarrhythmia.