应用冷冻球囊进行上腔静脉电隔离治疗心房颤动的初步探索

The initial experience of cryoballoon ablation for atrial fibrillation by isolation of superior vena cava

目的探索冷冻消融治疗心房颤动(简称房颤)中应用冷冻球囊进行上腔静脉电隔离的安全性和有效性。方法 4例房颤患者在局麻下接受第二代冷冻球囊冷冻消融手术。在肺静脉隔离后进行上腔静脉冷冻消融达到电隔离。观察术中电隔离相关冷冻参数和膈神经麻痹等主要并发症。术后3个月后进行临床随访观察冷冻消融治疗房颤效果。结果患者均为男性,其中2例为阵发性房颤,2例为持续性房颤。4例患者均在第一次冷冻开始后(36.3±19.3)s达到上腔静脉电隔离,即刻温度(-33.3±5.0)℃,冷冻消融总时间(61.8±26.9)s,最低温度(-40.5±4.4)℃。术中均无血流动力学障碍、穿孔、迷走神经反应、膈神经麻痹和窦性心动过缓等主要并发症发生。术后3个月随访均未见快速型房性心律失常事件发生。结论采用第二代冷冻球囊进行上腔静脉冷冻电隔离治疗房颤的初步经验是安全有效的。

Objective To describe and analyze the key points of applying the cryoballoon ablation to atrial fibrilai ton trigged by superior vena cava （SVC） after the regular cryoballoon-based pulmonary vein isolation. Method A total of four patients were included in this study, who were all diagnosed atrial fibrillation and treated by eryoballoon ablation of the second generation. After all pulmonary vein potentials were isolated, we placed the cryoballoon into the ostium of SVC for ablation.We collected the information in these operations, and followed up all of four patients 3 months later after the operations. Results All of the four patients were males, two of whom were diagnosed paroxysmal atrial fibrillation, another two with continuous atrial fibrillation.The potentials in SVC had achieved isolation in （36.3±19.3） seconds at the first ablation in SVC in all of them. The temperature in the SVC reached （36. 3±19.3）s at the moment of isolation. The total time in SVC ablation were （61.8±26.9）s, and the minimum temperature were （-40.5±4.4）℃. There were no serious complications, such as hemodynamic changes, vasovagal reflex, phrenic nerve paralysis,sinus bradycardia, or perforations. And no atrial tachycardia recurred 3 months after the operations. Conclusion From our experience, it can be safe and effective to apply the eryoballoon ablation in SVC to treat atrial fibrillation.