房颤消融术后早期房性心律失常预测房颤复发

Early atrial arrhythmia after different ablation of paroxysmal atrial fibrillation predicted the recurrence of atrial fibrillation

目的对比二代冷冻球囊消融(Cryoballoon Ablation,CBA)与消融指数(Ablation index,AI)指导下的射频导管消融(Radiofrequency Ablation,RFA)对阵发性心房颤动患者的疗效,并探讨两种消融方式术后早期(1月内)房性心律失常(Early atrial arrhythmias,EA)对复发的预测价值。方法入选2020年5月至2022年8月于马鞍山市人民医院接受CBA(n=31)和AI指导下RFA(n=32)治疗的阵发性房颤(Paroxysmal atrial fibrillation,PAF)患者进行分析,对比两组患者基线资料、手术参数、并发症和随访资料,评估两种消融方式治疗PAF的疗效以及术后EA对复发的预测价值。结果①术后平均随访时间(13.7±3.2)个月,CBA组及RFA组术后分别有5例(16.1%)和6例(18.8%)房颤复发,无显著性差异(P>0.05);②CBA组与RFA组比较,EA预测术后房颤复发具有较高的敏感性、特异性和准确性(80.0%vs.50.0%、76.9%vs.57.7%、77.4%vs.56.3%)。CBA组术后早期房性心律失常对术后无复发率的影响存在统计学差异(Log Rank P=0.034),而RFA组无显著性差异(Log Rank P=0.562)。结论阵发性房颤患者冷冻球囊消融及消融指数指导下的射频导管消融均是安全有效的;冷冻球囊消融术后早期房性心律失常对术后复发具有更高的预测价值。

Objective To compare the efficacy of cryoballoon ablation(CBA)with radiofrequency catheter ablation(RFA)guided by ablation index in patients with paroxysmal atrial fibrillation(PAF)and to investigate the predictive value of early atrial arrhythmias(EA)in the postoperative period(within 1 month)for recurrence of both ablation modalities.Methods Patients with PAF treated with CBA(31 patients)and ablation index(AI)guided RFA(32 patients)at Ma'anshan People's Hospital from May 2020 to August 2022 were enrolled for analysis to compare the basic data,procedural parameters,complications and follow-up data of the two groups and to assess the efficacy of the two ablation modalities for PAF and the predictive value of EA for recurrence.Results①The mean follow-up after ablation was(13.7±3.2)months,and there were 5(16.1%)and 6(18.8%)recurrences after ablation in the CBA and RFA groups respectively,with no significant differences(P>0.05).②The sensitivity,specificity and accuracy of EA in predicting postoperative recurrence were higher in the CBA group than in the RFA group(80.0%vs.50.0%,76.9%vs.57.7%,77.4%vs.56.3%).There was a statistically significant difference in the effect of EA on non-recurrence rate in the CBA group(Log Rank P=0.034),but not in the RFA group(Log Rank P=0.562).Conclusions Both cryoballoon ablation and AI-guided radiofrequency catheter ablation are safe and effective in patients with paroxysmal atrial fibrillation;atrial arrhythmias occurring early post-ablation of CBA have a higher predictive value than radiofrequency ablation for predicting postoperative recurrence.