新一代冷冻球囊能提高冷冻消融治疗心房颤动的远期疗效

目的探讨新一代冷冻球囊能否提高冷冻消融治疗心房颤动（简称房颤）的远期疗效。方法回顾性分析2012年1月至2013年6月序贯接受冷冻球囊消融治疗的房颤患者的介入治疗与术后门诊随访资料。根据术中使用球囊类型不同将患者分为第一代（G1）组和第二代（G2）组。术后3个月后的规律门诊随访中如有房颤或心房扑动或房性心动过速复发的心电学证据则判定为冷冻消融治疗失败。术前经胸超声测量左房前后径。结果共105例患者纳入研究，其中G1组57例，G2组48例。G2组术中即刻肺静脉隔离成功率高于G1组98．7％（150／152）VS94．6％（174／184），P=0．0429]。G2组不同肺静脉最低冷冻温度均明显低于G1组（P〈0．01），冷冻消融时间30（16，44）minVS35（25，55）min，P〈0．0001]、手术时间105（75，145）minVS120（80，190）min，P=0．0056]、X线曝光时间17（13，28）minVS20（13，32）min，P=0．0470]均明显低于G1组。G1组1例发生心包积液，G2组4例（8．3％）发生手术相关主并发症（2例膈神经麻痹，2例短暂性脑缺血发作）。在平均13（5，20）个月随访期内73例完成随访，46例维持窦性心律。G2组冷冻消融术后成功率明显高于G1组89．3％（25／28）VS46．7％（21／45），P=0．0002]。生存分析亦证实G2组成功率高于G1组（Log—Rank=5．0238，P=0．0250）。复发患者左房内径较大（48±7）mmVS（44±6）mm，P=0．0079J。Logistic回归分析显示采用新球囊RR=9．524（2．511，36．121），P=0．0009]与冷冻消融成功率提高独立相关。结论采用新一代冷冻球囊冷冻消融治疗房颤不仅能够缩短术中冷冻标测和消融时间，提高即刻肺静脉隔离成功率，还能提高远期随访成功率，但是在早期应用中主并发症发生率稍高。

New generation cryoballoon can improve long-term outcome of cryoablation for atrial fibrillation

Objective To investigate whether the second generation cryoballoon （ G2 ） could improve the outcome of atrial fibrillation （AF） patients after long-term of follow-up when compared to a first generation cryoballoon （ G1 ）. Methods The cryoablation and follow-up data of patients who were first-time treated for AF by a 28-mm cryoballoon from January 2012 to June 2013 were analyzed. According to the different cryoballoon used, the patients were divided to two groups, the G1 group which treated by GI （ArcticFront） and the G2 group which treated by G2（ ArcticFront Advance）. The failure treatment of cryoablation was defined as any detected episode of AF, atrial flutter, atrial tachycardia which lasted for 30 seconds after 3 months later post cryoablation. Left atrium diameter （LAD） was measured by transthoracic echocardiography before cryoablation. Results A total of 105 patients （ G1/G2 group： n = 57/48 ） were enrolled in this study. The success rate of immediately pulmonary vein isolation （PVI） in the G2 group was higher than that in the G1 group 98.7 % （150/152） vs 94.6 % （174/184） , P=0. 042 9]. The mean minimum temperatures attained in the G2 group during different pulmonary vein eryoablation were lower than that in the G1 group （P〈0.01）. The mean eryomapping time 30（ 16, 44） min vs 35（25, 55） min, P〈0. 000 1], the mean total proeedure time 105（75, 145） min vs 120（80, 190） min, P=0.0056] and the mean total X ray exposure time 17（13, 28） min vs 20（13, 32） min, P=0.047 0] in the G2 group were shorter then that in the G1 group. One patient in the G1 group occurred cardiac infusion during atrial septum puncture. In the G2 group, two patients occurred transient phrenic nerve paralysis, other two patients occurred transient isehemic attack, and all above patients were recovery. During mean 13 5, 20] months follow-up, a total of 73 patients had complete follow-up data, and 46 （63.0%） patients were maintained sinus rhythm. The treat-failur