冷冻消融治疗心房颤动的进展及临床评价
苏晞,张劲林
摘要(Abstract):
<正>利用射频能源进行心房颤动(房颤)导管消融是一项成熟的治疗技术,其疗效(尤其对于阵发性房颤)逐渐得到认可。但与阵发性室上性心动过速射频消融相比,其繁琐的手术操作、相对漫长的学习曲线及一定比例的并发症限制了该项技术的推广。近年来,将冷冻能源及专门设计的球囊导管应用于肺静脉隔离成为房颤治疗领域的一项新技术,在全世界范围应用近4万例[1],国内目前尚处于起步和推广阶段。本文重点对冷冻球囊应用进展及临床评价进行综述。
关键词(KeyWords): 心房颤动;冷冻消融;肺静脉隔离;射频消融
基金项目(Foundation):
作者(Author): 苏晞,张劲林
参考文献(References):
- [1]Fitzgerald DM.Catheter ablation of atrial fibrillation:to freeze,or not to freeze,that is the question.J Cardiovasc Electrophysiol,2014,25:8-10.
- [2]Khairy P,Chauvet P,Lehmann J,et al.Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation.Circulation,2003,107:2045-2050.
- [3]Vogt J,Heintze J,Gutleben KJ,et al.Long-term outcomes after cryoballoon pulmonary vein isolation:results from a prospective study in 605 patients.J Am Coll Cardiol,2013,61:1707-1712.
- [4]Hakalahti A,Biancari F,Nielsen JC,et al.Radiofrequency ablation vs.antiarrhythmic drug therapy as first line treatment of symptomatic atrial fibrillation:systematic review and metaanalysis.Europace,2015,17:370-378.
- [5]Packer DL,Kowal RC,Wheelan KR,et al.Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation:first results of the North American Arctic Front(STOP-AF)pivotal trial.J Am Coll Cardiol,2013,61:1713-23.
- [6]Andrade JG,Khairy P,Guerra PG,et al.Efficacy and safety of cryoballoon ablation for atrial fibrillation:A systematic review of published studies.Heart Rhythm,2011,8:1444-1451.
- [7]Cappato R,Calkins H,Chen SA,et al.Worldwide survey on the methods,efficacy,and safety of catheter ablation for human atrial fibrillation.Circulation,2005,111:1100-1105.
- [8]杨国澍,蔡琳,王新华,等.持续性心房颤动线性消融及不同阻滞线与复发的关系分析.中国介入心脏病学杂志,2013,21:83-87.
- [9]St?ckigt F,Schrickel JW,AndriéR,et al.Atrioesophageal fistula after cryoballoon pulmonary vein isolation.J Cardiovasc Electrophysiol,2012,23:1254-1257.
- [10]Fürnkranz A,Bordignon S,Schmidt B,et al.Luminal esophageal temperature predicts esophageal lesions after second generation cryoballoon pulmonary vein isolation.Heart Rhythm,2013,10:789-793.
- [11]Lakhani M,Saiful F,Parikh V,et al.Recordings of diaphragmatic electromyograms during cryoballon ablation for atrial fibrillation accurately predict phrenic nerve injury.Heart Rhythm,2014,11:369-374.
- [12]Fürnkranz A,Bordignon S,Schmidt B,et al.Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon.J Cardiovasc Electrophysiol,2013,24:492-497.
- [13]Metzner A,Reissmann B,Rausch P,et al.One-year clinical outcome after pulmonary vein isolation using the secondgeneration 28-mm cryoballoon.Circ Arrhythm Electrophysiol,2014,7:288-292.
- [14]Fürnkranz A,Bordignon S,Schmidt B,et al.Incidence and characteristics of phrenic nerve palsy following pulmonary vein isolation with the second-generation as compared with the firstgeneration cryoballoon in 360 consecutive patients.Europace,2015,17:574-578.
- [15]Schmidt M,Dorwarth U,Andresen D,et al.Cryoballoon versus RF ablation in paroxysmal atrial fibrillation:results from the German Ablation Registry.J Cardiovasc Electrophysiol,2014,25:1-7.
- [16]Jourda F,Providencia R,Marijon E,et al.Contact-force guided radiofrequency vs.second-generation balloon cryotherapy for pulmonary vein isolation in patients with paroxysmal atrial fibrillation-a prospective evaluation.Europace,2015,17:225-231.
- [17]Fürnkranz A,Brugada J,Albenque JP,et al.Rationale and Design of FIRE AND ICE:multicenter randomized trial comparing efficacy and safety ofpulmonary vein isolation using cryoballoon versus radiofrequency ablation with 3D-reconstruction.J Cardiovasc Electrophysiol,2014,25:1314-1320.
- [18]Neumann T,Wójcik M,Berkowitsch A,et al.Cryoballoon ablation of paroxysmal atrial fibrillation:5-year outcome after single procedure and predictors of success.Europace,2013,15:1143-1149.
- [19]Conte G,Chierchia GB,Sieira J,et al.Repeat procedure using radiofrequency energy for recurrence of atrial fibrillation after initial cryoballoon ablation:a 2-year follow-up.Europace,2013,15:1421-1425.
- [20]Pokushalov E,Romanov A,Artyomenko S,et al.Cryoballoon versus radiofrequency for pulmonary vein re-isolation after a failed initial ablation procedure in patients with paroxysmal atrial fibrillation.J Cardiovasc Electrophysiol,2013,24:274-279.
- [21]Fürnkranz A,Chun KR,Nuyens D,et al.Characterization of conduction recovery after pulmonary vein isolation using the″single big cryoballoon″technique.Heart Rhythm,2010,7:184-190.
- [22]Ghosh J,Martin A,Keech AC,et al.Balloon warming time is the strongest predictor of late pulmonary vein electrical reconnection following cryoballoon ablation for atrial fibrillation.Heart Rhythm,2013,10:1311-1317.
- [23]Jackson N,Barlow M,Leitch J,et al.Treating atrial fibrillation:pulmonary vein isolation with the cryoballoon technique.Heart Lung Circ,2012,21:427-432.
- [24]Ferrero-de Loma-Osorio A,Izquierdo-de Francisco M,MartínezBrotons A,et al.Medium-term results of cryoballoon ablation of the pulmonary veins in patients with paroxysmal and persistent atrial fibrillation.First experience of a Spanish center.J Interv Card Electrophysiol,2013,37:189-196.