阵发性房颤二代冷冻球囊消融术后复发的相关因素

Risk factors of paroxysmal atrial fibrillation recurrence after second‑generation cryoballoon ablation

目的:探讨二代冷冻球囊治疗阵发性心房颤动的有效性以及安全性,并分析其术后复发的相关危险因素。方法:研究纳入2017年2月至2021年10月于南京鼓楼医院行二代冷冻球囊消融术的阵发性心房颤动患者。记录患者的基线临床资料、术中冷冻消融参数、手术并发症和随访结果。手术后3、6、12个月及以后每12个月进行规律的门诊及电话随访。根据术后是否复发分组,比较两组患者的差异,并通过多因素Logistic回归分析术后复发的独立危险因素。房颤复发定义为术后3个月以后常规心电图或24 h动态心电图提示持续时间≥30 s的房颤、房扑、房速。结果:总共204例患者被纳入分析,年龄为(61.27±10.25)岁,中位病程为15(3,60)个月,其中110(53.9%)例为男性患者,共10(4.9%)例患者出现手术并发症。术中累计消融833根肺静脉,每根肺静脉平均消融(1.89±0.31)次,平均消融时间为(277.34±38.94)s,平均最低温度为(-48.19±3.95)℃。总计135(66.2%)例患者在冷冻过程中监测到肺静脉隔离时间(TTI),平均TTI时间为(35.41±13.00)s。在中位随访37(25,46)个月后,房颤复发率为20.1%(41/204)。复发组男性占比、血红蛋白低于未复发组,平均最低温度高于未复发组,差异有统计学意义(P=0.013;P=0.045;P=0.001)。在记录到TTI时间的患者中,复发组TTI时间长于未复发组(P=0.037)。多因素回归分析显示,平均最低温度(OR=1.174,95%CI:1.063~1.297,P=0.002)是二代冷冻球囊术后房颤复发的独立预测因素,平均最低温度>-42.87℃可以预测房颤复发。结论:二代冷冻球囊消融是治疗房颤的安全、高效的手段。复发组及未复发组患者在男性占比、血红蛋白、平均最低温度、平均TTI时间均有显著差异。平均最低温度是房颤复发的独立预测因素,平均最低温度>-42.87℃可预测房颤复发,敏感性为36.6%,特异性为96.3%。

Objective:To evaluate the efficacy and security of second‑generation cryoballoon ablation of paroxysmal atrial fibrillation,as well as to assess the risk of postoperative relapse.Methods:The study included patients with paroxysmal atrial fibrillation who underwent second‑generation cryoballoon ablationat Nanjing Drum Tower Hospital from February 2017 to October 2021.Baseline clinical data,cryoablation parameters,surgical complications,and follow‑up results were recorded.Outpatient serviceand telephone follow‑up were conducted on patients for any recurrence at the end of 3,6,12months,and then every 12 months post‑operation.The patients were split into recurrence andnon‑recurrence groups.Multivariate logistic regression was employed to examine the associated recurrencefactors following cryoablation.Recurrence of atrial fibrillation was defined as atrial fibrillation,atrial flutter,and atrial tachycardia persisting for more than 30 seconds,which was indicated by routineelectrocardiogram or 24‑hour dynamic electrocardiogram after 3 months of surgery.Results:A totalof 204 patients were included in this study.The mean age of the participants was 61.27±10.25years,and the median duration of illness was 15 months(interquartile range:3 to 60 months).Amongthem,110(53.9%)were male patients,and 10(4.9%)patients had surgical complications.A totalof 833 pulmonary veins were isolated during the operation.The average ablation times of each pulmonaryvein were(1.89±0.31)times,the average ablation time was(277.34±38.94)s,and the averageminimum temperature was(-48.19±3.95)℃.A total of 135(66.2%)patients were recordedthe pulmonary vein isolation time(TTI).The average TTI was(35.41±13.00)s.After a medianfollow‑up of 37 months(with an interquartile range of 25 to 46 months),the recurrence rate of atrial fibrillationwas 20.1%(41/204).The male proportion and hemoglobin levels in the recurrence groupwere lower than in the non‑recurrence group,and the average minimum temperature in recurrencegroup was higher(P=0.013,P=0.045,and P=0.001,respectively).In the patients with TTI documented,the average TTI in recurrence group was longer than that in non‑recurrence group(P=0.037).Regression analysis of multiple variables revealed that the average minimum temperature wasan independent predictor of atrial fibrillation recurrence after second‑generation cryoballoon ablation(OR=1.174,95%CI:1.063‑1.297,P=0.002).The average minimum temperature>-42.87℃could predict the recurrence of atrial fibrillation.Conclusion:Second‑generation cryoballoon ablationis a safe and efficacious way to treat paroxysmal atrial fibrillation.There were significant differences inmale proportion,hemoglobin level,mean minimum temperature,and the average TTI between therecurrence group and the non‑recurrence group.The average minimum temperature is an independentpredictor of postoperative recurrence.The mean minimum temperature of-42.87℃could be adoptedto predict the postoperative recurrence with a sensitivity of 36.6%and a specificity of 96.3%.