肺静脉前庭扩大冷冻消融治疗阵发性心房颤动早期疗效分析

Short-term Analysis on Efficacy of Extended Pulmonary Antrum Cryoablation in Patients With Paroxysmal Atrial Fibrillation

目的:探索肺静脉前庭扩大冷冻消融治疗阵发性心房颤动(房颤)的早期疗效及安全性。方法:回顾性分析2018年1月至2019年12月于福建省立医院行第二代冷冻球囊导管消融(CBA)治疗阵发性房颤患者249例。根据术式不同分为肺静脉前庭扩大冷冻消融组(PVIPLUS组,n=106例)和单纯肺静脉电隔离组(PVI组,n=143例)。观察两组并发症及12个月成功率以评估肺静脉前庭扩大冷冻消融的安全性及早期疗效。结果:249例阵发性房颤患者随访中位数15(6~31)个月,有209例(83.94%)维持窦性心律。PVIPLUS组CBA术后的成功率明显高于PVI组[89.62%(95/106)vs.79.72%(114/143),P=0.035],生存分析同样显示PVIPLUS组CBA术后12个月的成功率高于PVI组(HR=0.402,95%CI:0.202~0.875,log-rank P=0.035)。应用Logistic回归分析显示,与单纯肺静脉电隔离相比,采用肺静脉前庭扩大冷冻消融方法(OR=0.455,95%CI:0.216~0.959,log-rank P=0.039)与提高阵发性房颤CBA成功率独立相关,同时左心房内径增大(OR=2.077,95%CI:1.143~3.777,log-rank P=0.017)与术后复发率独立相关,术后复发的患者左心房内径大于术后成功患者。两组共出现10例(4.02%)并发症[PVIPLUS组4例(3.77%),PVI组6例(4.20%)];其中主要并发症为短暂性膈神经麻痹6例(2.41%),PVIPLUS组2例(1.89%),PVI组4例(2.80%);PVIPLUS组1例发生迷走反射,3例(PVIPLUS组1例,PVI组2例)出现术后右侧股静脉穿刺部位血肿。PVIPLUS组与PVI组并发症发生率差异无统计学意义(P=1.000)。结论:肺静脉前庭扩大冷冻消融治疗阵发性房颤是安全、有效的,可降低阵发性房颤CBA术后早期复发风险,提高成功率。左心房内径增大是阵发性房颤患者CBA术后复发的独立危险因素。

Objectives:To explore the short-term efficacy and safety of extended pulmonary antrum cryoablation in patients with paroxysmal atrial fibrillation.Methods:The clinical data of 249 patients with paroxysmal atrial fibrillation(PAF),who underwent pulmonary vein ablation by second-generation cryoballoon from January 2018 to December 2019 in Fujian provincial hospital and finished one year follow-up,were retrospectively analyzed.According to application of the extended antrum ablation or not,patients were divided into extended pulmonary antrum ablation group(PVIPLUS group)and pulmonary vein isolation alone group(PVI group).Safety and efficacy were compared between the two groups based follow up results.Results:A total of 249 patients with PAF were included in this study,there were 106 patients in PVIPLUS group and 143 patients in PVI group.After 15(6-31)months follow-up,209 patients(83.94%)maintained sinus rhythm.The success rate after ablation was significantly higher in the PVIPLUS group than in the PVI group(89.62%[95/106]vs.79.72%[114/143],P=0.035).Survival analysis also showed that the success rate in the PVIPLUS group after 12 months was higher than that in the PVI group(HR=0.402,95%CI:0.202-0.875,log-rank P=0.035).Logistic regression analysis showed that compared with isolated pulmonary veins alone,extended pulmonary antrum ablation was independently related to improved success rate of cryoablation of PAF(OR=0.455,95%CI:0.216-0.959,log-rank P=0.039),and the size of left atrium(OR=2.077,95%CI:1.143-3.777,log-rank P=0.017)was independently related to the recurrence rate of PAF after cryoablation.The left atrial diameter of patients with AF recurrence after cryoablation was larger than that of patients without AF recurrence,and the baseline left atrial diameter of the both groups was similar.In total,10 cases(4.02%)of operation-related complications occurred,there were 4 cases(3.77%)in the PVIPLUS group and 6 cases(4.20%)in the PVI group.There were 6 cases(2.41%)transient phrenic nerve palsy(PVIPLUS group vs.PVI group[1.89%vs.2.80%,P>0.05]),1 case vagal reactions in the PVIPLUS group.3 cases(one in the PVIPLUS group and two in the PVI group)experienced hematoma at the puncture site of the right femoral vein.All postoperative complications were improved after related treatment.There was no significant difference in the incidence of operation-related complications between the PVIPLUS group and the PVI group(P=1.000).Conclusions:Extended pulmonary antrum cryoablation for PAF is safe and efficacious and could reduce the incidence of early AF recurrence after cryoablation.The increase in left atrial diameter is an independent risk factor for early AF recurrence after cryoablation in patients with paroxysmal atrial fibrillation.