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

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Journal of Geriatric Cardiology 2020年第8期17卷 476-485页

作者： Zhong-Jing CAO Xiao-Gang GUO Qi SUN Jian-Du YANG Hui-Qiang WEI Shu ZHANG Jian MA Arrhythmia Center State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Cardiology Guangdong Cardiovascular InstituteGuangdong Provincial People's HospitalGuangdong Academy of Medical ScienceGuangzhouChina

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 *** study aimed to evaluate the efficacy and safety of CBA in HCM patients with *** We retrospectively analyzed HCM patients among 1253 patients with symptomatic AF who underwent CBA for pulmonary vein isolation in a single *** study analyzed the AF recurrence and assessed the CBA indexes,including nadir temperature,time-to-isolation,CBA failure,pulmonary vein potentials(PVPs),and redo *** 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 *** one-year AF-free rates were 79.0%vs.63.0%(non-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(Ppulmonary veins,which had the lowest *** 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 *** freedom from AF for HCM patients after CBA is relatively low compared to that for non-HCM patients.

关键词： Atrial fibrillation Cryoballoon ablation Hypertrophic cardiomyopathy pulmonary vein isolation

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

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World Journal of Clinical Cases 2022年第12期10卷 3872-3878页

作者： Yu-Cheng Wu Mei-Xiang Wang Ge-Cai Chen Zhong-Bao Ruan Qing-Qing Zhang Department of Cardiology Taizhou People’s HospitalTaizhou 225300Jiangsu ProvinceChina Department of Endocrinology Taizhou People’s HospitalTaizhou 225300Jiangsu ProvinceChina

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 *** 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 *** had a history of AF,ASD,coronary heart disease with stent implantation and *** and laboratory examinations showed no *** score of CHA2DS2VASc was 3,and HAS-BLED was *** revealed a 25-mm secundum *** vein(PV)and LAA anatomy were assessed by cardiac computed *** mapping with 10-pole Lasso catheter was performed following ablation of all four PVs with complete *** the cryoballoon PVI,the patient underwent LAA occlusion under transesophageal echocardiographic ***,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 *** Sequential cryoballoon PVI and LAA occlusion prior to ASD closure can be performed safely in AF patients with ASD.

关键词： Atrial fibrillation Atrial septal defect Cryoballoon pulmonary vein isolation Left atrial appendage occlusion Case report

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Paroxysmal atrial fibrillation ablation:Achieving permanent pulmonary vein isolation by point-by-point radiofrequency lesions

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World Journal of Cardiology 2017年第3期9卷 230-240页

作者： Alonso Pedrote Juan Acosta Beatriz Jáuregui-Garrido Manuel Frutos-López Eduardo Arana-Rueda Arrhythmia Section Cardiology DepartmentVirgen del Rocío University Hospital41013 SevilleSpain

pulmonary vein isolation by point-by-point radiofrequency catheter ablation constitutes the cornerstone of catheter ablation strategies for the treatment of atrial fibrillation. However, despite advances in pulmonary vein isolation ablation strategies, long-term success rates after ablation remain suboptimal, which highlights the need to develop techniques to achieve more durable lesions. Strategies proposed to improve the durability of pulmonary vein isolation can be divided into two groups: Those addressed to improving the quality of the lesion and those that optimize the detection of acute PV reconnection during the ablation procedure. This manuscript reviews the role and potential benefits of these techniques according to current clinical evidence.

关键词： Atrial fibrillation pulmonary vein isolation Lesion durability Contact force pulmonary vein reconnection

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

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South China Journal of Cardiology 2017年第1期18卷 62-72页

作者：文明洪刘松史亚星纪阳韩兆帅 Department of Cardiology Affiliated Hospital of Qingdao University Medical College Department of operating room Affiliated Hospital of Qingdao University Medical College

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 *** 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.

关键词： paroxysmal atrial fibrillation cryoballoon, catheter ablation pulmonary vein isolation meta- analysis

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Plasma N-terminal pro-Brain natriuretic peptide levels after hybrid therapy with pulmonary vein isolation and amiodarone for atrial fibrillation

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South China Journal of Cardiology 2010年第1期11卷 10-14页

作者：董小莉谭宁邓宇珺 Guangdong Cardiovascular Institute Guangdong General Hospital Guangdong Academy of Medical Sciences

Background The purpose of this study was to investigate the effect of hybrid therapy and the relationship between the plasma N-terminal pro-Brain natriuretic peptide （NT-pro BNP） levels and the recurrence rate of the atrial fibrillation （AF） patients underwent pulmonary vein isolation （PVI） with or without amiodarone. Methods There were two groups in this study： control group and hybrid group. In the control group, 54 patients （36 males, 54±13 years） including paroxysmal （PAF） 22, persistent （Pers-AF） 15, and permanent AF （perm-AF） 17, respectively, underwent the PVI procedure only; In the hybrid, 63 AF patients （41 males, 53±12 years） including PAF 24, Pers-AF 18, and perm-AF 21, respectively,underwent the PVI procedure and used amiodarone to enhance the effect of PVI. Blood samples were collected before and 3 months after PVI. NT-pro BNP concentrations were determined by immunoassays. Results In the control group, AF recurred in 29 patients （PAF 5 in 22, Pers-AF 11 in 15, and perm-AF 13 in 17） after the initial PVI procedure; And in the hybrid group, AF recurrred in 20 patiens （PAF 3 in 24, Pers-AF 7 in 18, and perm-Af 11 in 21 ）. The average recurrent rate decreased significantly in the hybrid group （53.7% vs 31.7%, P0.01）. While the NT pro- BNP level （pg/mL） was significantly different between the 2 groups （PAF 294.34±54.4 versus 241.69±17.6 pg/mL, P=0.047; Pers-AF 487.51±47.9 versus 248.76±19.4, P=0.001; Perm-AF 490.91±38.3 versus 300.86±31.8, P=0.032）, While the NT pro- BNP level was also much lower in hybird group than control group in total （263.43±26.1 versus 409.88±49.7, P=0.02）. Conclusions Sinus rhythm（SR）following AF ablation is associated with a dramatic decrease in NT-pro BNP. The hybrid group which had the administration of amiodarone after PVI would significantly decrease the plama NT pro-BNP levels and the recurrent rate of AF.

关键词： atrial fibrillation hybrid therapy pulmonary vein isolation amiodarone N-terminal pro-Brain natriuretic peptide

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Reversal of pulmonary vein remodeling after catheter ablation of atrial fibrillation

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Journal of Geriatric Cardiology 2016年第2期13卷 163-168页

作者： Jia-Hui WU Hung-Kei LI Daniel M Couri Philip A Araoz Ying-Hsiang Lee Chang-Sheng MA Douglas L Packer Yong-Mei CHA Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing China Heart Rhythm Specialists Phoenix Arizona USA Prairie Cardiovascular Consultants Ltd. Springfield Illinois USA Department of Radiology Mayo Clinic Rochester Minnesota USA Department of Cardiovascular Medicine Mackay Memorial Hospital Taipei Taiwan China Division of Cardiovascular Diseases Mayo Clinic Rochester Minnesota USA

Background pulmonary veins （PV） and the atria undergo electrical and structural remodeling in atrial fibrillation （AF）. This study aimed to determine PV and left atrial （LA） reverse remodeling after catheter ablation for AF assessed by chest computed tomography （CT）. Methods PV electrophysiologic studies and catheter ablation were performed in 63 patients （68% male; mean ± SD age： 56 ± 10 years） with symptomatic AF （49% paroxysmal, 51% persistent）. Chest CT was performed before and 3 months after catheter ablation. Results At baseline, patients with persistent AF had a greater LA volume （91 ±29 cm3 vs. 66 ± 27 cm3; P = 0.003） and mean PV ostial area （241 ＋ 43 mm2 vs. 212 ± 47 mm2; P = 0.03） than patients with paroxysmal AF. There was no significant correlation between the effective refractory period and the area of the left superior PV ostium. At 3 months of follow-up after ablation, 48 patients （76%） were AF free on or off antiarrhythmic drugs. There was a significant reduction in LA volume （77 ±31 cm3 to 70 ± 28 cm3; P 〈 0.001） and mean PV ostial area （224 ± 48 mm2 to 182 ± 43 mm2; P 〈 0.001）. Patients with persistent AF had more reduction in LA volume （11.8 ± 12.8 cm3 vs. 4.0 ± 11.2 cm3; P = 0.04） and PV ostial area （62 mm2 vs. 34 mm2; P = 0.04） than those who have paroxysmal AF. The reduction of the averaged PV ostial area was significantly correlated with the reduction of LA volume （r = 0.38, P = 0.03）. Conclusions Catheter ablation of AF improves structural remodeling ofPV ostia and left atrium. This finding is more apparent in patients with persistent AF treated by catheter ablation.

关键词： Ablation Atrial fibrillation Computed tomography Left atrium pulmonary vein isolation pulmonary vein ostial area

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Epicardial isolation of pulmonary veins with ethanol in open chest dogs

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Chinese Medical Journal 2011年第11期124卷 1714-1719页

作者： YIN Xian-dong NING Man SANG Cai-hua MIAO Cheng-long LIANG Cui TANG Ri-bo LONG De-yong YU Rong-hui LIU Xing-peng DONG Jian-zeng MA Chang-sheng Department of Cardiology Beijing Anzhen Hospital CapitalMedical University Beijing 100029 China

Background Radiofrequency （RF） ablation has become a widely accepted treatment for atrial fibrillation （AF）. This study aimed to identify the efficacy and safety of pulmonary vein （PV） ablation with ethanol and to explore an alternative energy source for catheter ablation of AF. Methods Twelve open-chest mongrel dogs were randomized into ethanol ablation group and control group. Both the injections and electrophysiological mapping procedures were performed epicardialy. In ethanol ablation group （n=-6）, injections were performed to circumferentially ablate the root of each PV （0.2 ml each site, 3 mm apart） with 95% ethanol using an 1 ml injector. In control group （n=6）, saline was injected other than ethanol.

关键词： ethanol pulmonary vein isolation epicardial atrial fibrillation

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Strategies of catheter ablation of persistent atrial fibrillation

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Chinese Medical Journal 2013年第14期126卷 2603-2606页

作者： MAChang-sheng Department of Cardiology Anzhen Hospital Capital Medical University Beijing 100029 China

Atrial fibrillation （AF） is the commonest type of arrhythmia which is seen as a growing public healthburden affecting patients＇ morbidity and mortality.1 Since the end of last century, catheter ablation has been evolving as the treatment of choice in a particular subset of patients with AF,2＇3 and currently being the most common catheter ablation procedure performed worldwide. Most centers have progressively moved from performing paroxysmal AF to more complex long-standing persistent AF.

关键词： atrial fibriIlation catheter ablation pulmonary vein isolation

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

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World Journal of Cardiovascular Diseases 2022年第1期12卷 65-76页

作者： Mohamed Sanhoury Gaetano Fassini Salvatore Pala Massimo Moltrasio Fabrizio Tundo Stefania Riva Antonio Dello Russo Michela Casella Claudio Tondo Cardiac Arrhythmia Research Centre Department of Cardiovascular Sciences University of Milan Centro Cardiologico Monzino IRCCS Milan Italy Electrophysiology Unit Department of Cardiology and Angiology University of Alexandria Alexandria Egypt

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 dur... 详细信息

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.

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Mechanisms and clinical significance of early recurrences of atrial arrhythmias after catheter ablation for atrial fibrillation

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World Journal of Cardiology 2016年第11期8卷 638-646页

作者： Jackson J Liang Sanjay Dixit Pasquale Santangeli Division of Cardiology Electrophysiology SectionHospital of the University of Pennsylvania

Early recurrence of atrial arrhythmias(ERAA) after ablation is common and strongly predicts late recurrences and ablation failure. However, since arrhythmia may eventually resolve in up to half of patients with ERAA, guidelines do not recommend immediate reintervention for ERAA episodes occurring during a 3-mo postablation blanking period. Certain clinical demographic, electrophysiologic, procedural, and ERAA-related characteristics may predict a higher likelihood of longterm ablation failure. In this review, we aim to discuss potential mechanisms of ERAA, and to summarize the clinical significance, prognostic implications, and treatment options for ERAA.

关键词： Atrial fibrillation Recurrence Catheter ablation pulmonary vein isolation

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