Feasibility and safety of cryoballoon ablation for atrial fibrillation inpatients with congenital heart disease

BACKGROUND The prevalence of atrial fibrillation (AF) is on the rise in the aging population with congenital heart disease (CHD). A few case series have described the feasibility and early outcomes associated with radiofrequency catheter ablation of AF centered on electrically isolating pulmonary veins (PV) in patients with CHD. In contrast, cryoballoon ablation has not previously been studied in this patient population despite its theoretical advantages, which include a favorable safety profile and shorter procedural time. AIM To assess the safety and feasibility of cryoballoon ablation for AF in an initial cohort of patients with CHD. METHODS The study population consisted of consecutive patients with CHD and cryoballoon ablation for AF at the Montreal Heart Institute between December 2012 and June 2017. Procedural complications, acute success, and 1-year freedom from recurrent AF after a single procedure with or without antiarrhythmic drugs were assessed. Procedures were performed under conscious sedation. Left atrial access was obtained via a single transseptal puncture or through an existing atrial septal defect (ASD). Cryoballoon occlusion was assessed by distal injection of 50% diluted contrast into the pulmonary vein. At least one 240-second cryothermal application was performed upon obtaining complete pulmonary vein occlusion. Following ablation, patients were routinely followed at outpatient visits at 1, 3, 6, and 12 mo, and then annually. RESULTS Ten patients, median age 57.9 (interquartile range 48.2-61.7) years, 60% female, met inclusion criteria and were followed for 2.8 (interquartile range 1.4-4.5) years.Two had moderately complex CHD (sinus venosus ASD with partial anomalous pulmonary venous return;aortic coarctation with a persistent left superior vena cava), with the remainder having simple defects. AF was paroxysmal in 8 (80.0%) and persistent in 2 (20.0%) patients. The pulmonary vein anatomy was normal in 6 (60.0%) patients. Four had left common PV (n = 3) and/or 3 right PV (n = 2). Electrical pulmonary vein isolation (PVI) was acutely successful in all. One patient had transient phrenic nerve palsy that recovered during the intervention. No major complication occurred. One year after a single ablation procedure, 6 (60%) patients remained free from AF. One patient with recurrent AF had recovered pulmonary vein conduction and underwent a second PVI procedure. A second patient had ablation of an extra-pulmonary vein trigger for AF. CONCLUSION Cryoballoon ablation for AF is feasible and safe in patients with simple and moderate forms of CHD, with an excellent acute success rate and modest 1-year freedom from recurrent AF.

Impact of Pulmonary Vein Anatomy on Long-term Outcome of Cryoballoon Ablation for Atrial Fibrillation

Variant pulmonary vein anatomy （PVA） has been reported to influence the recurrence of atrial fibrillation （AF） after radiofrequency ablation. However, the effects of PVA on AF in patients undergoing cryoballoon ablation （CBA） remain unknown. The present study aimed to examine the impact of PVA on the long-term outcome of CBA for AF. A total of 78 patients （mean age 60.7±10.9 years, 64.1% males） with symptomatic and drug-refractory paroxysmal AF were enrolled in the study. Left atrium （LA） and PVA acquired at computed tomography angiography （CTA） were reconstructed with CARTO 3 SYSTEM. Patients were routinely evaluated by 24-hour Holter monitoring following CBA. Cox regression was used to detect the predictors of AF recurrence after CBA. The results showed abnormal PVA in 30 patients （38.5%） and 18 patients （23.1%） had left common PV （LCPV）. Electrical pulmonary vein isolation was achieved in all patients. After a mean follow-up of 689.5±103.8 days, it was found that patients with abnormal PVA had similar AF recurrence rate to those with normal PVA （26.7% vs. 25.0%, P=0.54）, and there was no significant difference in AF recurrence rate between LCPV patients and non-LCPV patients （33.7% vs. 23.3%, P=0.29）. Cox regression analysis showed that AF duration （72.9±9.0 vs. 42.3±43.2 months, HR 1.001; 95%CI 1.003- 1.014; P〈0.001） and cryo-applications of right-side PVs （3.0±1.6 vs. 4.7±1.7, HR 0.661; 95% CI 0.473-0.925; P=0.016） were independent predictors of freedom from AF, but PVA was not identified as a predictor of long-term success. In conclusion, the variant PVA cannot significantly influence the long-term outcome of AF patients undergoing CBA; longer AF duration and less cryo-applications of right-side PVs are associated with higher AF recurrent rate.

Pulmonary vein isolation implemented by second-generation cryoballoon for treating hypertrophic cardiomyopathy patients with symptomatic atrial fibrillation:a case-control study

Background Atrial fibrillation(AF)is a generally acknowledged turning-point of the natural history of hypertrophic cardiomyopathy(HCM);however,data from the cryoballoon ablation(CBA)for AF in HCM patients are relatively scarce.The study aimed to evaluate the efficacy and safety of CBA in HCM patients with AF.Methods We retrospectively analyzed HCM patients among 1253 patients with symptomatic AF who underwent CBA for pulmonary vein isolation in a single center.The study analyzed the AF recurrence and assessed the CBA indexes,including nadir temperature,time-to-isolation,CBA failure,pulmonary vein potentials(PVPs),and redo procedure.Results A total of 108 patients were included(mean age:59.0±6.9 years),27 patients(25%)had HCM,with the median follow-up duration of 25.5 months.The one-year AF-free rates were 79.0%vs.63.0%(non-HCM vs.HCM),while the two-year AF-free rates were 77.8%vs.55.1%[hazard ratio(HR)=2.758,log-rank P=0.024].Patients with persistent AF had poor AF-free rates compared to those with paroxysmal AF(P<0.001).The CBA failure was the most common in the right inferior pulmonary veins,which had the lowest PVPs.Multivariate Cox regression analysis indicated that HCM and persistent AF were risk factors for AF recurrence(HR=2.74,95%CI:1.29–5.79,P=0.008;and HR=3.97,95%CI:1.85–8.54,P<0.001,respectively).Conclusions The CBA can be effectively and safely used to treat HCM patients with symptomatic AF.The freedom from AF for HCM patients after CBA is relatively low compared to that for non-HCM patients.

Role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in cryoballoon ablation outcomes for paroxysmal atrial fibrillation

BACKGROUND Cryoballoon ablation(CBA)is recommended for patients with paroxysmal atrial fibrillation(AF)refractory to antiarrhythmic drugs.However,only 80%of patients benefit from initial CBA.There is growing evidence that pretreatment with angiotensin-converting enzyme inhibitors(ACEIs)and angiotensin receptor blockers(ARBs)decreases the recurrence of AF postablation,particularly in nonparoxysmal AF undergoing radiofrequency ablation.The role of ACEIs and ARBs in patients with paroxysmal AF in CBA remains unknown.We decided to investigate the role of ACEIs and ARBs in preventing the recurrence of atrial arrhythmia(AA)following CBA for paroxysmal AF.AIM To investigate the role of ACEIs and ARBs in preventing recurrence of AA following CBA for paroxysmal AF.METHODS We followed 103 patients(age 60.6±9.1 years,29%women)with paroxysmal AF undergoing CBA 1-year post procedure.Recurrence was assessed by documented AA on electrocardiogram or any form of long-term cardiac rhythm monitoring.A multivariable Cox proportional hazard model was used to assess if ACEI or ARB treatment predicted the risk of AA recurrence.RESULTS After a 1-year follow-up,19(18.4%)participants developed recurrence of AA.Use of ACEI or ARB therapy was noted in the study population.Patients on ACEI/ARB had a greater prevalence of hypertension and coronary artery disease.On a multivariate model adjusted for baseline demographics and risk factors for AF,ACEI or ARB therapy did not prevent recurrence of AA following CBA(P=0.72).Similarly,on Kaplan–Meier analysis pretreatment with ACEI/ARB did not predict the time to first recurrence of AA(P=0.2173).CONCLUSION In our study population,preablation treatment with an ACEI or ARB had no influence on the recurrence of AA following CBA for paroxysmal AF.

Cryoballoon ablation on an elder paroxysmal atrial fibrillation patient implanted with double chamber pacemaker: a case report

Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,increasing in prevalence with age.Catheter ablation is recommended to symptomatic paroxysmal AF refractory or intolerant to at least one Class I or III antiarrhythmic medication.[1]Main current catheter ablation of AF with radiofrequency can give priority to,other include freezing,ultrasonic and laser ablation etc.Recent studies provides substantial information regarding the efficacy and safety of novel cryoballoon technology in creating pulmonary vein(PV)isolation.[2,3]Processed in cyroballoon ablation,some AF patients implanted with double chamber pacemaker are difficult to puncture atrial septal,because of the atrial electrode.My case report was as follows.

Cryoballoon pulmonary vein isolation and left atrial appendage occlusion prior to atrial septal defect closure: A case report

BACKGROUND In patients who suffer from both atrial fibrillation(AF)and atrial septal defect(ASD),cryoballoon pulmonary vein isolation(PVI),sequential left atrial appendage(LAA)occlusion and ASD closure could be a strategy for effective prevention of stroke and right heart failure.CASE SUMMARY A 65-year-old man was admitted to our institution due to recurrent episodes of palpitations and shortness of breath for 2 years,which had been worsening over the last 48 h.He had a history of AF,ASD,coronary heart disease with stent implantation and diabetes.Physical and laboratory examinations showed no abnormalities.The score of CHA2DS2VASc was 3,and HAS-BLED was 1.Echocardiography revealed a 25-mm secundum ASD.Pulmonary vein(PV)and LAA anatomy were assessed by cardiac computed tomography.PV mapping with 10-pole Lasso catheter was performed following ablation of all four PVs with complete PVI.Following the cryoballoon PVI,the patient underwent LAA occlusion under transesophageal echocardiographic monitoring.Lastly,a 34-mm JIYI ASD occlude device was implanted.A follow-up transesophageal echocardiography at 3 mo showed proper position of both devices and neither thrombi nor leakage was found.CONCLUSION Sequential cryoballoon PVI and LAA occlusion prior to ASD closure can be performed safely in AF patients with ASD.

PR-segment depression during cryoballoon ablation of atrial fibrillation: a case report

Cryoballoon ablation has been widely used in the treatment of atrial fibrillation (AF).[1] The main complications of the procedure include pericardial tamponade, pulmonary vein stenosis, and atrial esophageal leakage, etc.[2] But there has been hardly any reporting of PR-segment changes caused by cryoballoon ablation of AF.

Study of the Impact of the Patient Rhythm during Cryoballoon Ablation on the Acute Biophysical Parameters

Background: Pulmonary vein isolation by means of cryoballoon is a well-established way of treatment of atrial fibrillation. The aim of the study was to compare the acute cryoballoon biophysical parameters attained during energy applications to the individual pulmonary vein during sinus rhythm versus atrial fibrillation. Methods: 100 Patients who underwent their first-time PVI using second-generation cryoballoon for symptomatic and drug-refractory AF, between the beginning of March to end of August 2016, were initially screened. 61 patients with paroxysmal AF were included in the present study. 39 patients with persistent AF were excluded. No pre-procedural anatomical imaging was reported. Results: A total of 61 patients (male 80%, age 59.3 ± 13.4 years) were included in the present analysis. A total of 243 pulmonary veins were isolated with an average of 1.87 ± 1.14 cryo energy applications per individual vein. During cryo application, there were no significant differences between applications delivered during sinus rhythm or ongoing AF in the rate of temperature drop at 5 and 30 s, rate of warming at 5 s after freezing stop or achieved balloon nadir temperature. The same also was observed for both the balloon cooling rate and warming times. Conclusions: The present analysis shows no impact of the patient baseline rhythm at the time of energy application upon the acute balloon biophysical parameters in patients with normal sinus rhythm and those with ongoing atrial fibrillation using the second-generation cryoballoon.

二代冷冻球囊治疗心房颤动合并高血压的安全性和有效性研究

目的本研究旨在回顾性分析二代冷冻球囊导管治疗心房颤动合并高血压的有效性和安全性。方法选择在福建省立医院接受二代球囊冷冻消融手术的1027例房颤患者,回顾性分析两组基线资料、术中参数及并发症发生情况。利用Kaplan-Meier法计算术后12个月、24个月及36个月两组房颤患者无房扑/房颤发生的概率。结果高血压组与非高血压组在合并糖尿病、冠心病、BMI、年龄、左房大小、CHA2DS2-VASC评分、HAS-BLED评分差异有统计学意义(P>0.05);两组术中参数差异无统计学意义;围手术期主要并发症相似(3.3%vs.3.0%,P=1),两组术后12个月、24个月及36个月的成功率分别为:82.0%vs.81.2%;74.9%vs.72.9%;66.3%vs.72.9%。生存曲线差异无统计学意义(95%CI:0.75,1.4,P=0.23)。结论二代冷冻球囊肺静脉电隔离PVI治疗房颤合并高血压与治疗非高血压一样,有良好的安全性和成功率。

心房颤动冷冻球囊消融术围手术期护理方案的构建及应用

目的 探讨心房颤动冷冻球囊消融术围手术期护理方案的构建及应用。方法 选取2020年9月至2021年8月及2021年10月至2022年9月在上海交通大学医学院附属瑞金医院接受冷冻球囊消融术的260例患者为研究对象,将2020年9月至2021年8月未接受围手术期护理方案的130例患者作为对照组,2021年10月至2022年9月接受围手术期护理方案的130例患者为研究组。观察两组一般临床资料及术后24 h内常见并发症发生率及疼痛情况,以评价该护理方案的效果。结果 两组年龄、性别、体重指数、学历、婚姻、付费方式、术中肝素用量、穿刺部位、凝血酶原时间、激活全血凝血时间、国际标准化值、既往消融次数比较,差异均无统计学意义(P>0.05)。研究组肢体麻木发生低于对照组(P<0.05);两组术后4、8 h患者不同疼痛程度比较,差异有统计学意义(P<0.05)。结论 心房颤动冷冻球囊消融术围手术期护理方案可降低术后并发症发生率,增加患者舒适度。

心律失常与起搏领域临床研究2023年度进展

回顾2023年心律失常领域重要临床试验,涉及心房颤动(房颤)、起搏等方面。CIRDADOSE研究及EARLY-AF研究均肯定冷冻球囊消融治疗房颤疗效,减慢房颤进展。MANIFEST-PF研究回顾房颤脉冲场消融的成功率及安全性,在ADVENT研究中再次证实其安全性和有效性不劣于传统热消融。在左束支区域起搏(LBBAP)研究中,与双心室起搏(BVP)相比,LBBAP降低持续性室性心动过速(VT)/心室颤动(VF)和新发房颤发生率。对于起搏比例高且射血分数降低的起搏器或植入式心律转复除颤器(ICD)患者,BUDAPEST CRT升级研究肯定了其升级到心脏再同步除颤器(CRT-D)的明确获益。DANPACEⅡ研究显示窦房结功能障碍患者的心房起搏最小化并不能降低房颤的发生率。IDE研究显示Aveir DR双腔无导线起搏器术后3个月安全性良好,可提供可靠的心房起搏和房室同步。iSUSI研究是对皮下植入式心律转复除颤器的注册研究,发现心力衰竭和非心力衰竭患者不恰当和恰当电击率相似。

Comparison of cryoballoon ablation for atrial fibrillation guided by real-time three-dimensional transesophageal echocardiography vs. contrast agent injection

Background:Pulmonary vein (PV) occlusion generally depends on repetitive contrast agent injection when cryoballoon ablation for atrial fibrillation (AF). The present study was to compare the effect of cryoballoon ablation for AF guided by transesophageal echocardiography (TEE) vs. contrast agent injection.Methods:Eighty patients with paroxysmal AF (PAF) were enrolled in the study. About 40 patients underwent cryoballoon ablation without TEE (non-TEE group) and the other 40 underwent cryoballoon ablation with TEE for PV occlusion (TEE group). In the TEE group during the procedure, PVs were displayed in 3-dimensional images to guide the balloon to achieve PV occlusion. The patients were followed up at regularly scheduled visits every 2 months.Results:No differences were identified between the groups in regard to the procedure time and cryoablation time for each PV. The fluoroscopy time (6.7±4.2 min vs. 17.9±5.9 min, P<0.05) and the amount of contrast agent (3.0±5.1 mL vs.18.1±3.4 mL, P<0.05) in the TEE group were both less than the non-TEE group. At a mean of 13.0±3.3 mon follow-up, success rates were similar between the TEE group and non-TEE group (77.5% vs. 80.0%, P=0.88).Conclusions:Cryoballoon ablation with TEE for occlusion of the PV is both safe and effective. Less fluoroscopy time and a lower contrast agent load can be achieved with the help of TEE for PV occlusion during procedure.

心房颤动冷冻球囊导管消融术后医源性房间隔缺损的研究进展

冷冻球囊导管消融是治疗心房颤动(房颤)的有力手段,此手术需要使用大直径鞘管穿过房间隔进行复杂操作。然而,房间隔穿刺术后遗留的长期左向右分流,即医源性房间隔缺损带来的不良事件逐渐引发术者关注。本文旨在对冷冻球囊导管消融术后医源性房间隔缺损的影响因素、不良事件及监测与处理进行综述。

二代冷冻球囊消融术应用于75岁及以上心房颤动患者的安全性和有效性分析

目的 评价二代冷冻球囊应用于75岁及以上心房颤动(房颤)患者行肺静脉隔离的安全性和有效性。方法 回顾性研究。连续纳入2018年1月至2022年12月泰达国际心血管病医院使用二代冷冻球囊治疗的年龄≥75岁的房颤患者104例,定义为≥75岁组[男性51例(49.0%),持续性房颤26例(25.0%)];以性别和房颤类型相匹配的同期年龄<75岁的患者104例为对照组。统计围手术期并发症评价安全性,随访12个月统计术后房颤复发率评价有效性。结果 ≥75岁组患者平均年龄为(78.5±3.1)岁,对照组为(62.0±8.4)岁。两组患者冷冻消融术后3个月空白期后,随访12个月手术成功率比较差异无统计学意义(72.1%比76.9%,χ~2=0.633,P=0.426)。Logistic回归分析发现,持续性房颤(OR=3.024,95%CI:1.326~6.896,P=0.001)、体质指数(OR=1.131,95%CI:1.012~1.264,P=0.027)和手术时间(OR=1.028,95%CI:1.012~1.045,P=0.001)是房颤复发的独立危险因素。≥75岁组患者手术并发症有10例,包括6例股静脉穿刺相关并发症、3例膈神经损伤和1例心包积液;对照组有2例,包括1例股静脉血肿和1例膈神经损伤,两组手术并发症发生率比较差异有统计学意义(9.6%比1.9%,P=0.017)。结论 75岁及以上房颤患者应用二代冷冻球囊行肺静脉隔离是安全有效的,但需要警惕静脉血管穿刺相关并发症的发生。

使用二代冷冻球囊消融右下肺静脉难易程度的影响因素

目的分析心房颤动(房颤)使用二代冷冻球囊消融时影响右下肺静脉消融难易程度的因素。方法回顾性分析2019年6月至2022年3月在泰达国际心血管病医院首次使用二代冷冻球囊消融治疗房颤的患者234例,所有患者术前均已完善左心房CT血管造影(CTA)检查,收集其肺静脉内径(长径、短径)、内径比、测量右下肺静脉角度(下向角度、后向角度)、肺间距、开口高度、早分支情况等,根据右下肺静脉冷冻次数是否≥3次,分为容易组和困难组。结果纳入234例患者,年龄(62.8±8.1)岁,女性87例(37.2%),阵发性房颤164例(70.1%),困难组56例,容易组178例。所有患者均实现肺静脉隔离,容易组患者右下肺静脉冷冻的最低温度更低[(–48.0±6.2)℃比(–44.6±6.5)℃,P<0.001)],肺静脉电位实时记录率更高(49.4%比33.9%,P=0.042);困难组患者,早期病例(2019年度病例)的比例更高(46.4%比19.7%,P<0.001);容易组与困难组患者右下肺静脉下向成角差异有统计学意义[(59.5±12.3)°比(65.1±14.6)°,P=0.005];内径、内径比、两肺间距、开口高度、后向成角、早分支等差异均无统计学意义(均P>0.05)。纳入上述解剖因素和是否早期病例进行Logistic回归分析,下向成角和早期病例是影响肺静脉消融难易程度的独立危险因素(OR 0.968,95%CI 0.943~0.993,P=0.013;OR 0.285,95%CI 0.143~0.565,P=0.001)。受试者工作特征曲线显示,使用下向成角预测右下肺静脉封堵困难的曲线下面积0.745(95%CI 0.668~0.822,P<0.001),最佳截断值63.5°,敏感度67.9%,特异度71.9%。结论在冷冻消融术中,右下肺静脉的下向成角和术者的手术熟练度是影响手术难易程度的主要因素。

二代冷冻球囊消融作为阵发性心房颤动起始治疗的可行性研究

目的比较二代冷冻球囊消融与常规药物分别作为阵发性心房颤动(简称房颤)患者起始治疗的有效性与安全性。方法选取以二代冷冻球囊消融作为起始治疗的44例阵发性房颤患者作为消融组,观察手术时间、消融时间、X线透视时间、肺静脉隔离率、手术并发症等情况;选择同期住院且起始接受药物治疗的44例阵发性房颤患者作为药物组。两组均于出院后第1、3、6、12个月进行门诊随访,观察房颤复发率及并发症等情况,比较两组治疗的有效性与安全性。结果消融组手术时间、消融时间、X线透视时间分别为(108.0±39.0)min、(35.0±11.7)min、(10.0±6.9)min;肺静脉即刻隔离率为100%;手术相关并发症3例(6.8%),其中迷走神经反射1例、一过性膈神经损伤2例。药物组发生药物性窦性心动过缓2例,QTc延长1例,甲状腺功能降低1例。平均随访(12.0±5.9)个月后,消融组房颤复发率为11.4%,药物组房颤复发率为20.5%,消融组复发率显著低于药物组(P=0.033)。两组的并发症或不良反应发生率比较,差异无统计学意义(6.8%vs.9.1%,P=0.108)。结论与药物治疗相比,二代冷冻球囊消融治疗阵发性房颤成功率高,未增加并发症风险,可作为阵发性房颤的起始治疗策略之一。

射频消融或冷冻消融两种方法对左心房扩大房颤患者的治疗效果比较

目的对比射频消融或冷冻消融两种方法在左房扩大的房颤患者中是否存在治疗效果差异。方法选取自2016年12月至2022年5月期间前来福建省莆田市第一医院心血管内科房颤中心就诊并行导管消融术的左心房扩大(leftatrial volume index,LAVI)>34ml/m^(2)的房颤患者作为研究对象,共106例。根据术式,分成射频组(n=54)和冷冻组(n=52),比较两组术后房颤复发的情况。结果本研究中位随访时间为12个月,无死亡病例,失访率为3.8%,房颤消融后总体复发率为36.8%。两组临床基线情况及术后并发症差异无统计学意义(P>0.05);射频组的手术用时较长(P<0.001)、X-射线时间短、曝光量更少(P<0.05);生存分析结果显示,两组患者无房颤/房扑/房速生存率比较,差异无统计学意义(P>0.05)。结论对于左房扩大的房颤患者,两种术式临床效果相近。冷冻消融手术用时较短,而射频消融时医患所承受的X射线时间及曝光剂量更低,应根据实际情况选择合适的消融方法。

肺静脉解剖变异对持续性心房颤动患者冷冻消融疗效的影响

目的评估肺静脉解剖变异对持续性心房颤动(简称房颤)患者冷冻消融疗效的影响。方法回顾性分析98例接受冷冻球囊导管消融的持续性房颤患者的临床资料,按是否存在肺静脉变异将患者分为肺静脉变异组(21例)及非肺静脉变异组(77例)。比较两组患者的手术时间、放射暴露时长及剂量、术中并发症、手术成功隔离率以及各项随访指标。结果与非静脉变异组相比,肺静脉变异组消融手术时间[(35.1±13.4)min vs.(64.3±17.7)min]和放射暴露时长[(22.3±5.8)min vs.(33.6±6.0)min]均明显延长(P均<0.01),放射暴露CD值[(607.1±212.9)mGy vs.(1018.5±280.8)mGy]显著增加(P<0.01)。非静脉变异组一次隔离成功率明显高于静脉变异组(75/77 vs.16/21,P=0.01),但两组手术结束时肺静脉隔离均100%完成。随访一年时两组复发率间的差异无统计学意义(19/77 vs.6/21,P=0.726)。结论对于肺静脉变异的持续性房颤患者,冷冻消融治疗的急性期及长期成功率与非肺静脉变异患者相似。但肺静脉变异患者手术时间延长,且放射暴露增加。

围术期护理在阵发性心房颤动患者经皮冷冻球囊导管消融术中的应用效果

目的:探究围术期护理在阵发性心房颤动(简称房颤)患者经皮冷冻球囊导管消融术中的应用效果。方法:选择2021年6月—2023年6月徐州市中医院收治的80例阵发性房颤患者(均实施经皮冷冻球囊导管消融术治疗)为研究对象,采用抛硬币法分为试验组与参照组,各40例。参照组采用常规护理,试验组采用围术期护理,对比两组护理满意度、并发症发生率、负面情绪情况、生活质量。结果:护理后,与参照组相比,试验组护理总满意度、生活质量评分更高,并发症总发生率、负面情绪评分更低(P<0.05)。结论:围术期护理在阵发性房颤患者经皮冷冻球囊导管消融术中的应用效果良好,能够减少患者术后并发症发生率,减轻患者负面情绪,促进护理满意度、生活质量提升。

Comparison of the efficacy and safety of pulmonary vein isolation using cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation： An updated metaanalysis

Background Radiofrequency catheter ablation （RFCA） and cryoballoon ablation （CBA） are the two common ablation technologies used for the treatment of paroxysmal atrial fibrillation （PAF）. However, there is no consensus on which ablation method is the optimal choice. Methods We searched PubMed, EMBASE, Cochrane Library, Web of Knowledge and clinical trials.gov for clinically controlled trials （published up to January 11, 2017）. All included studies included fulfilled our previously defined criteria. The primary clinical outcome was the proportion of participants free from atrial fibrillation at 12-months follow-up. ; The secondary clinical outcomes were as the procedure time, fluoroscopy time, and total complications. Results We identified 573 studies, seven randomized controlled trials （RCTs） and 11 non-RCTs were included in this analysis （n=4982 participants）. Compared with RFCA, CBA had similar proportion of participants free from PAF at 12-months follow-up （70.8% vs. 69%; relative risk [RR] ： 1.01; 95% CI： 0.97 to 1.05）. Additionally, procedure time （149.61 vs. 174.73min; weighted mean difference WMD： 25.55; 95% CI： 44.69 to 6.41） was shorter in the CBA group, but the fluoroscopy time （34.52 vs. 38.59 min; WMD： 2.08; 95% CI： 5.86 to 1.71） did not have any significant difference. Total complication was not significantly different in both groups （RR： 1.22; 95% CI： 0.74 to 2.02 ）. Conclusions CBA is similar to RFCA with respect to clinical efficacy for PAF during the follow-up period of 12 months, and with no increased overall safety risk in the cryoballoon group CBA.