应用环状冷冻消融导管隔离肺静脉治疗阵发性心房颤动的初期体会

报告使用环状冷冻导管对阵发性心房颤动(AF)患者行肺静脉电隔离治疗的初期体会。对5例阵发性AF患者共18根肺静脉行冷冻消融,其中8根肺静脉(44.4%)单用环状冷冻导管平均消融3.2±1.5(2~5)次即能达到肺静脉的完全电隔离,10根肺静脉(55.6%)用环状冷冻导管消融后,需用普通射频导管在环形冷冻线上补点消融后才成功隔离肺静脉。随访3~6个月,4例(80%)无AF复发。消融后即刻选择性肺静脉造影和术后3个月核磁共振扫描检查均未发现肺静脉狭窄。结论:环状冷冻导管治疗阵发性AF安全性好,但隔离肺静脉的效率还需进一步提高。     

导管冷冻消融隔离肺静脉治疗心房颤动

目的探讨导管冷冻消融隔离肺静脉治疗心房颤动的临床疗效？方法回顾性分析15例进行冷冻消融治疗的心房颤动患者的临床资料．着重分析冷冻消融治疗的术前准备、手术方法、手术结果、术后并发症以及随访结果。结果存Lasso标测电极指导下了．用Arctic Circler冷冻消融导管在肺静脉开口附近进i了冷冻消融,隔离肺静脉直至肺静脉电位消失。13例阵发性心房颤动患者中．10例术中维持窦性心律,3例术中有短阵心房颤动发作,但均能自行终止。2例持续性心房颤动患者,1例于冷冻消融进行中终止心房颤动,1例未能在消融治疗中终止．在消融完成后行体外直流电复律1次,成功转为窦性心律,消融成功率为93．3ck（14／15）。共对15例心房颤动患者的54根肺静脉进行了电隔离,其中36根肺静脉单用环状冷冻导管消融4次～6次即能达到肺静脉的完全电隔离．18根肺静脉用环状冷冻导管消融后,需用普通射频消融导管在环形冷冻线上补点消融后才成功隔离肺静脉。术中、术后均无急性肺静脉狭窄等严重并发症发生。随访6个月～10个月,11例临床症状得到改善,无心房颤动复发,其中4例需服用抗心律失常药维持窦性心律,4例心房颤动复发。消融后即刻选择性肺静脉造影和术后6个月核磁共振扫描检查均未发现肺静脉狭窄。结论导管冷冻消融隔离肺静脉是治疗心房颤动的有效方法。     

应用环状冷冻消融导管行心房颤动电隔离术三例

探讨应用环状冷冻消融导管进行心房颤动(AF)肺静脉电隔离术的临床效果。对1例持续性AF、2例阵发性AF在肺静脉开口处进行冷冻肺静脉电隔离,温度-79℃,每次240～300s(4～5min)。3例共隔离10根肺静脉,消融4.9±2.8(4～10)次。手术时间为205±72(190～265)min。1例持续性AF患者消融后给予300J电复律恢复窦性心律,半月后复发,再次电复律后恢复窦性心律。1例术后一周内仍有阵发性AF。结论应用环状冷冻消融导管进行肺静脉电隔离术安全、有效。     

三维标测系统指导心房颤动导管消融的临床研究

目的 探讨三维标测系统指导下导管射频消融治疗心房颤动的有效性与安全性.方法 回顾性分析39例在三维标测系统指导下行环肺静脉线性消融术的心房颤动患者(其中阵发性心房颤动33例和持续性心房颤动6例)的临床资料,着重分析术前准备、标测及消融方法 、手术结果 、术后治疗和随访.结果 消融终点为Lagso标测的所有肺静脉均达到完全电学隔离,若消融结束后心房颤动仍未终止,即行同步直流电复律恢复窦性心律.39例患者共完成78条环形消融线,肺静脉完全电学隔离率为93.6%(73/78).手术操作时间为(245±56)min、X线曝光时间为(46±15)min.术后随访6个月～12个月,33例临床症状得到改善,无心房颤动复发,6例需服用抗心律失常药维持窦性心律,其中3例心房颤动复发患者接受再次导管消融后无发作.射频消融术后总成功率为84.6%(33/39).结论 三维标测系统指导下导管射频消融治疗心房颤动是安全和有效的治疗方法.     

三磷酸腺苷对阵发性心房颤动冷冻球囊消融术后肺静脉电传导恢复的影响及意义

目的探讨三磷酸腺苷(adenosine triphosphate,ATP)对阵发性心房颤动患者冷冻球囊消融后肺静脉电传导恢复的影响。方法对78例阵发性心房颤动患者在完成冷冻球囊肺静脉隔离予以ATP诱发肺静脉电传导恢复为观察组,对肺静脉电位恢复者再次冷冻重新达到肺静脉隔离。另有对照组77例阵发性心房颤动患者在完成常规冷冻消融术后不做诱导试验。比较两组患者术后复发率。结果观察组78例患者均完成肺静脉隔离;静脉注射ATP20mg后,有20例患者24根肺静脉出现肺静脉电传导恢复(14根左上肺静脉,4根左下肺静脉,2根右上肺静脉,4根右下肺静脉)。再行冷冻消融除1例外19例达到肺静脉隔离。对照组77例患者均顺利完成肺静脉隔离;经随访观察组12例(15. 38%)复发,对照组23例(29. 87%)复发(P 0. 05)。结论补充消融ATP"暴露"的肺静脉-左房电传导间隙,可以减少阵发性心房颤动的复发。     

8例阵发性心房颤动患者行冷冻球囊导管消融术的护理体会

目的总结阵发性心房颤动患者行冷冻球囊导管消融术的护理经验。方法回顾性分析本院行冷冻球囊导管消融术的8例阵发性心房颤动患者术前术后的护理方法,包括术前心理护理、术前常规检查、术后一般护理、用药护理、并发症的观察及护理、出院指导及随访等。结果 8例患者均成功行心房颤动冷冻球囊导管消融术,术中术后均无并发症发生。其中6例消融即刻转为窦性心律,2例肺静脉电隔离后心房颤动未终止,予同步电复律后转为窦性心律。术后3～5天好转出院。3～6个月随访期间8例患者均无心房颤动、心房扑动、房性心动过速等房性心律失常事件发生。结论冷冻球囊导管消融治疗阵发性心房颤动安全有效,有针对性的护理措施可有效促进患者术后恢复、减少并发症的发生,提高手术的安全性及疗效。     

冷冻直导管行肺静脉节段消融治疗心房颤动的短期效果

目的 探讨使用冷冻直导管节段消融肺静脉治疗心房颤动(房颤)的可行性和短期治疗效果.方法 选择临床确诊阵发性房颤患者11例,采用6 mn冷冻直导管、Lasso导管标测肺静脉电位,节段消融电隔离肺静脉,肺静脉电位消失30 min为消融隔离成功.结果 平均消融术时间(252.55±51.99)min,曝光时间(35.65±9.88)min.共隔离36根肺静脉,平均每根静脉冷冻(7.9±4.1)次.消融即刻成功率100%.平均随访(8.73±4.15)个月,短期成功率81.8%.结论 冷冻直导管节段消融肺静脉治疗房颤的短期效果较好.     

肥厚型心肌病患者心房颤动导管消融术后早期复发对远期预后的影响

目的:探讨肥厚型心肌病患者心房颤动导管消融术后早期复发对远期预后的影响.方法:纳入2006年11月至2016年7月,于北京安贞医院行首次房颤导管消融术的肥厚型心肌病患者共91例(阵发性心房颤动/持续性心房颤动:60/31例).消融策略:阵发性心房颤动患者行双侧肺静脉隔离;持续性心房颤动患者行双侧肺静脉隔离加左心房顶、二...     

心房颤动导管消融复发患者二次消融研究

目的心房颤动（房颤）导管消融治疗仍然存在一定的复发率,而其复发的特点目前仍然不清,本文对房颤消融复发患者二次消融的特点进行分析。方法共442例房颤消融治疗患者中,29例消融后复发的患者[男性19例,年龄（56±11）岁],本文患者复发时间〉6个月。对这些复发患者进行二次导管消融治疗。分析和对比初次与二次消融的电生理特点。结果29例房颤患者（20例为阵发性房颤,9例为持续性房颤）复发时间6—33（11．3±5．3）个月,所有患者初次消融后均服用3个月抗心律失常药。在复发的29例患者中,（1）3例初次消融术采用单纯靶肺静脉电隔离,二次消融发现1例出现非消融肺静脉触发灶,予以补充消融;另2例发现原靶肺静脉均有传导恢复,予以所有肺静脉经验性电隔离。（2）12例初次消融策略为所有肺静脉（48根）经验性电隔离,二次消融时发现所有患者存在不同程度的肺静脉传导恢复（36根）,8例再次所有肺静脉节段电隔离（其中1例发现上腔静脉起源予以针对性电隔离）;4例患者采用三维标测系统指导下同侧肺静脉环形电隔离。（3）12例患者初次消融策略为三维标测系统指导下同侧肺静脉环形电隔离,二次消融时重复进行环肺静脉电隔离。1例患者术中发现左心房局灶性房性心动过速（房速）并成功消融,2例患者术中出现左心房不典型心房扑动（房扑）成功消融。二次消融术后随访（15±10）个月,5例患者出现房颤复发（阵发性房颤1例,持续性房颤4例;成功率82．8％）,1例患者出现严重左肺静脉狭窄。结论对于房颤进行肺静脉消融电隔离治疗,其复发患者以肺静脉传导恢复为复发的主要原因。单纯进行靶肺静脉消融的部分患者,其他肺静脉的触发灶对于复发起着重要的作用。部分复发患者与非肺静脉起源的触发灶相关。复发的房颤患者,再次导管消融治疗可以达到较高的治疗成功率。     

冷冻球囊导管消融术的临床疗效及安全性分析

【】　目的　评价冷冻球囊导管消融术术的临床疗效及安全性。 方法　入选2014年6月至2015年6月华中科技大学附属同济医院就诊的38例阵发性房颤患者采用冷冻球囊技术进行房颤消融治疗。结果　房颤消融手术平均时间(125.5±38.2)min,平均透视时间(27.4±13.0)min,平均冷冻消融时间(36.9±12.8)min,导管消融即时成功率92.7%,平均每根肺静脉冷冻次数2～6(4. 0±1.2)次/根,各肺静脉即时成功率：左上肺静脉95.3%,左下肺静脉92.5%,右上肺静脉93.2%,右下肺静脉89.7%;术中行右上肺静脉消融时,并发膈神经麻痹1例,发生率2.6%;术后回访1例患者12个月内复发,复发率3%。结论　冷冻球囊消融术安全性高,具有良好的临床疗效     

阵发房颤冷冻消融术后复发二尖瓣环依赖性心房扑动1例

二尖瓣环依赖性房扑（PMF）是房颤射频消融术后发生率相对较高的心律失常,但对于阵发房颤的冷冻消融术后,其发生率较为罕见,关于PMF的治疗,目前较为常见的是二尖瓣峡部线消融。本文报告1例房颤冷冻消融术后发生房扑的病例,该患者经电生理检查证实为二尖瓣峡部依赖的心房扑动,且左房前壁存在低电压区,消融径线为从左侧环肺静脉消融区的前外侧至二尖瓣环后侧,贴近左心耳底部的水平消融线,获得成功,且至今未再复发。     

重复消融对阵发性心房颤动复发患者远期获益的评估

目的:评估重复消融对阵发性心房颤动复发患者的远期获益.方法:入选2000-01-2004-12期间经导管消融(肺静脉电隔离)的阵发性心房颤动患者106例.所有患者心房颤动的症状明显,超过2种抗心律失常药物治疗无效.结果:106例中,失访9例(8.5％),非心源性死亡3例,2次消融时出现一过性脑梗死未完成完整术式1例,其余93例均纳入随访,平均随访5年.1次消融远期维持窦性心律39例,成功率为41.9％.复发者54例中39例(72.2％)进行2次消融,其中27例(69.2％)远期维持窦性心律,消融远期成功率提高了29.0％;复发者12例中5例(41.7％)进行3次消融,其中2例(40.0％)远期维持窦性心律,使远期成功率再提高2.2％;复发者3例中2例(66.7％)再行4次消融,术后均再次复发心房颤动.重复消融累计远期成功率较1次消融明显提高(73.1％:41.9％,P＜0.01).包括重复消融在内,12个月内的总成功率为81.7％,平均远期复发时间是术后(28.4±8.3)个月.1次消融因电隔离肺静脉电传导恢复导致心房颤动远期复发(6例),经重复消融均可实现远期维持窦性心律.结论:远期复发心房颤动的主要机制是电隔离肺静脉的电传导恢复,重复消融有望实现和维持远期窦性心律.     

Catheter cryoablation of cardiac arrhythmias

PURPOSE OF REVIEW: The purpose of the review is to provide an update on the safety and efficacy of catheter cryoablation. RECENT FINDINGS: Catheter cryoablation is a safe and clinically effective method for ablation of atrioventricular nodal reentrant supraventricular tachycardia. Although the acute procedural success rate of catheter cryoablation for this arrhythmia may be slightly lower than that reported for radiofrequency ablation, it has an excellent safety profile, with no reported instances of inadvertent atrioventricular block requiring implantation of a permanent pacemaker. Using this technology, one can perform reversible cryomapping, which helps to identify suitable ablation targets while identifying sites where cryoablation should be avoided. For patients with midseptal and parahissian accessory pathways, in whom the risk of producing inadvertent atrioventricular block is substantial, catheter cryoablation is a safe and effective alternative to radiofrequency ablation. Catheter cryoablation of common atrial flutter causes much less patient discomfort than radiofrequency ablation, with excellent acute and long-term efficacy. Catheter cryoablation also can be used to isolate the pulmonary veins during ablation of atrial fibrillation. As compared with radiofrequency ablation, the risk of acute thromboembolic complications and of pulmonary vein stenosis appears to be lower with cryoablation. SUMMARY: For many cardiac arrhythmias, catheter cryoablation is a safe and effective alternative to radiofrequency ablation. The ability to identify suitable ablation targets by reversible cryomapping is a particularly useful feature of this technology. Although the acute procedural success rate of cryoablation may not equal that of radiofrequency ablation in all circumstances, as catheter technology evolves it is likely that the efficacy of cryoablation will improve and the list of arrhythmias that can be treated with this method will expand.     

Acute results of transvenous cryoablation of supraventricular tachycardia (atrial fibrillation,atrial flutter,Wolff-Parkinson-White syndrome,atrioventricular nodal reentry tachycardia)

INTRODUCTION: Radiofrequency (RF) catheter ablation currently is used for treatment of cardiac arrhythmias. Although the success rate is high for almost all supraventricular tachycardias (SVT), this technique has some drawbacks, especially when pulmonary veins (PV) are targeted for treatment of atrial fibrillation (AF). Additionally, new techniques for isolation of the PVs have the drawback that they can be used only for PV isolation and not for routine treatment of other SVTs. The aim of this study was to report on the safety and efficacy of a new cryoablation system for treatment of all SVTs. METHODS AND RESULTS: Forty-nine patients with SVT (38 men; age 48 years, range 23-76) were enrolled in the study. Five patients were withdrawn from the study before they underwent cryoablation. The remaining 44 patients were treated with cryoablation (22 AF, 15 atrial flutter, 3 accessory pathway, 2 AV nodal reentrant tachycardia, 1 AV junction ablation for permanent AF, 1 atrial tachycardia). Cryoablation was performed with the CryoCor cryoablation system, which uses a precooling system and N2O as a refrigerant. The number of freezes applied varied according to the index arrhythmia treated. Successful isolation of PVs was performed in 20 of (96%) 21 AF patients and 53 of 55 veins. The overall acute success was 98% (43/44). Fifty-three PVs were isolated (2.5/patient). The success rate was 100% (23/23) for right-sided procedures. The average and nadir temperatures reached in right-sided and left-sided procedures were -77 degrees C and -80 degrees C and -75 degrees C and -78 degrees C, respectively. No acute PV stenosis was seen. CONCLUSION: This novel cryoablation system appears to be safe and can successfully treat different types of SVTs, including AF. Isolation of PVs is possible without producing stenosis. Despite the high blood flow in the right atrial isthmus and PVs, bidirectional conduction block can be achieved.     

Limited posterior left atrial cryoablation in patients with chronic atrial fibrillation undergoing valvular heart sugery

OBJECTIVES: We sought to evaluate whether a limited surgical cryoablation of the posterior region of the left atrium was safe and effective in the cure of atrial fibrillation (AF) in patients with associated valvular heart disease. BACKGROUND: Extensive surgical ablation of AF is a complex and risky procedure. The posterior region of the left atrium seems to be important in the initiation and maintenance of AF. METHODS: In 32 patients with chronic AF who underwent heart valve surgery, linear cryolesions connecting the four pulmonary veins and the posterior mitral annulus were performed. Eighteen patients with AF who underwent valvular surgery but refused cryoablation were considered as the control group. RESULTS: Sinus rhythm (SR) was restored in 25 (78%) of 32 patients immediately after the operation. The cryoablation procedure required 20 +/- 4 min. There were no intraoperative and perioperative complications. During the hospital period, one patient died of septicemia. Thirty-one patients reached a minimum of nine months of follow-up. Two deaths occurred but were unrelated to the procedure. Twenty (69%) of 29 patients remained in SR with cryoablation alone, and 26 (90%) of 29 patients with cryoablation, drugs and radiofrequency ablation. Three (10%) of 29 patients remained in chronic AF. Right and left atrial contractility was evident in 24 (92%) of 26 patients in SR. In control group, two deaths occurred, and SR was present in only four (25%) of 16 patients. CONCLUSIONS: Linear cryoablation with lesions connecting the four pulmonary veins and the mitral annulus is effective in restoration and maintenance of SR in patients with heart valve disease and chronic AF. Limited left atrial cryoablation may represent a valid alternative to the maze procedure, reducing myocardial ischemic time and risk of bleeding.     

Phrenic nerve identification with cardiac multidetector computed tomography

Cryoballoon ablation of the pulmonary veins is a new technique that has proven useful in preventing paroxysmal and persistent atrial fibrillation recurrence. One of the most serious complications of this method is right phrenic nerve palsy. The usefulness of multidetector computed tomography to locate the right phrenic nerve and artery and predict the risk of phrenic nerve palsy during cryoablation according to the distance between the right phrenic neurovascular bundle and the right superior pulmonary vein ostium has recently been described. Fifty-five consecutive patients with paroxysmal atrial fibrillation (52 ± 12 years) underwent balloon cryoablation, following multidetector computed tomography to measure the pulmonary veins. We were able to identify segments of the right pericardiacophrenic artery (mean length 25 mm [range 7-68 mm]) in only 10 patients (20%).Full English text available from: www.revespcardiol.org     

Anatomic predictors of recurrence after cryoablation for atrial fibrillation: a computed tomography based composite score

Journal of Interventional Cardiac Electrophysiology - Effective pulmonary vein isolation (PVI) with cryoablation depends on adequate occlusion of pulmonary veins (PV) by the cryoballoon and is...     

Experiência de um Centro Brasileiro com Crioablação para Isolamento Elétrico das Veias Pulmonares na Fibrilação Atrial Paroxística e Persistente – Resultados Preliminares no Brasil

Background Electrical isolation of the pulmonary veins is recognized as the cornerstone of non-pharmacological treatment of Atrial Fibrillation (AF), and therefore, has been recommended as the first step in AF ablation according to all guidelines. Even though the cryoballoon technology is widely used in North America and Europe, this experience is still incipient in many developing countries such as Brazil.Objective To evaluate initial results regarding success and safety of the new technology in patients with persistent and paroxysmal AF.Methods One hundred and eight consecutive patients with symptomatic AF refractory to pharmacological treatment were submitted to cryoablation for isolation of the pulmonary veins. Patients were separated into two groups according to AF classification: persistent (AF for over one week); or paroxysmal (shorter episodes). Recurrence and procedural safety data were analyzed respectively as primary and secondary outcomes. The level of significance was 5%.Results One hundred and eight patients, with mean age 58±13 years, 84 males (77.8%), underwent cryoablation. Sixty-five patients had paroxysmal AF (60.2%) and 43 had persistent AF (39.2%). The mean time of the procedure was 96.5±29.3 minutes and the mean fluoroscopy time was 29.6±11.1 minutes. Five (4.6%) complications were observed, none fatal. Considering a blanking period of 3 months, 21 recurrences (19.4%) were observed in a one-year follow-up period. The recurrence-free survival rates of AF in the paroxysmal and persistent groups were 89.2% and 67.4%, respectively.Conclusion Cryoablation for electrical isolation of the pulmonary veins is a safe and effective method for the treatment of AF. Our results are consistent with other studies suggesting that this technology can be used as an initial technique even in cases of persistent AF. (Arq Bras Cardiol. 2020; 115(3):528-535)