二代冷冻球囊电隔离上腔静脉起源的心房颤动有效性及安全性分析

Efficacy and safety of second-generation cryoballoon for atrial fibrillation originating from superior vena cava

目的探讨二代冷冻球囊电隔离上腔静脉起源的心房颤动(房颤)有效性及安全性.方法入选2017年1月10日至2018年3月20日在阜外医院接受二代冷冻球囊治疗的房颤患者680例,其中上腔静脉起源的房颤患者13例.回顾性分析上腔静脉起源的房颤患者手术资料及术后随访情况,包括冷冻消融上腔静脉电隔离时间、隔离时温度、冷冻次数、射频补点次数、术中并发症以及术后房颤复发情况.结果冷冻上腔静脉电隔离时间大部分在20 s内,但上腔静脉电位易恢复,冷冻消融次数为1~4次,冷冻时间最长不超过150s.10例(76.92%)患者成功冷冻消融隔离上腔静脉,3例(23.08%)术中隔离上腔肺静脉后易恢复,经补点射频消融成功隔离上腔静脉.术中出现一过性膈神经麻痹、一过性交界性心律、窦性停搏,一过性膈神经麻痹及急性上腔静脉阻塞综合征在停止冷冻后均恢复.所有患者在随访(9.7±4.2)个月后均无并发症发生,无房颤复发.结论二代冷冻球囊可用于隔离上腔静脉,部分患者上腔静脉电隔离后易恢复,需要射频消融补点消融.部分患者可出现一过性邻近器官并发症但可逆,停止冷冻消融后上述功能损害均可恢复正常.

Objective To investigate the efficacy and safety of the second-generation cryoballoon for atrial fibrillation (AF) originating from superior vena cava (SVC).Methods A total of 680 patients with AF who underwent second-generation cryoablation in Beijing Fuwai Hospital from January 10,2017 to March 20,2018.Thirteen patients with AF originating from SVC were enrolled.Perioperative data and follow-up data of patients with AF were analyzed,which include time to isolation (TTI),cryoablation temperature,number of cryoablation,number of touch-up ablation,operative complications,and AF recurrence.Results TTI was within 20 seconds,but SVC potential was easy to recover.The number of cryoablation was not more than four times.The cryoablation timewas no longer than 150seconds.Ten patients (76.92%) succeeded in cryoablation and isolation of SVC.Three patients (23.08%) were easily recovered after isolation of SVC and pulmonary vein.SVC was successfully isolated by touch-up ablation.During the operation,transient phrenic nerve palsy,transient junctional rhythm,sinus arrest,and acute SVC obstruction syndrome occurred,and all of them were recovered at the end of operation.All patients had no complications during the follow-up (9.7±42.) monthsand no recurrence of AF.Conclusion The second-generation cryoballoon can be used for SVC.Some SVC potential recovered patients need radiofrequency ablation of touch up.Some patients were transient adjacent organ complications but can be reversible.