摘要目的探讨冷冻球囊导管消融治疗心房颤动(房颤)的方法、策略和短期随访结果。方法2013年11月至2015年1月连续入选就诊于阜外医院接受冷冻球囊导管消融术的房颤患者共70例。在冷冻球囊导管消融过程中,利用环状标测导管对肺静脉电位进行实时记录。消融终点为肺静脉完全电隔离。术后进行常规随访。结果在进行了平均(14．0±4．3)次/例消融后,以上70例患者的282支肺静脉中有274支(97．2%)达到了成功电隔离。平均手术时间为(115．2±24．8) min,透视时间(29．6±8．9) min。总计232支(84．3%)肺静脉成功实时记录肺静脉电隔离。其中持续隔离组的电隔离时间(45．61±1．97) s,显著短于传导恢复组(97．30±7．57) s,P<0．0001。持续隔离组的首次电隔离的球囊最低温度(-46．35±0．55)℃,也显著低于传导恢复组(-40．16±1．26)℃,P<0．0001,而两组隔离时球囊温度差异无统计学意义[持续隔离组：(-33．95±0．69)℃,传导恢复组：(-36．42±2．0)℃,P=0．1428]。60 s的隔离时间为预测术中肺静脉持续隔离的最佳界值(敏感性0．76,特异性0．82)。平均随访5．1个月,空窗期后成功率为76%。多因素分析证实左心房扩大、吸烟和早期复发为房颤复发的独立危险因素。结论冷冻球囊导管操作相对简单,学习曲线较短。在冷冻球囊导管对肺静脉进行消融时,利用环状标测导管可以在大多数肺静脉中记录到肺静脉电位。肺静脉电隔离时间可以有效预测术中肺静脉恢复传导。冷冻球囊导管治疗房颤是安全、有效的。

abstractsObjective To summarize the application of cryoballoon technique for the treatment of atri-al fibrillation ( AF) in a Chinese arhythmia center and report the short-term outcomes. Methods Seventy pa-tients with AF underwent cryoballoon ablation were consecutively included. Good occlusion of pulmonary veins ( PV) was attempted. During ablation,real-time PV potentials were recorded using an integrated circular map-ping catheter. After successful PV isolation,a waiting period of 30 minutes was applied to access early reconduc-tion. Reconducted PVs were to cryoablation again to achieve full scale PV isolation at the end of the procedure. A blank window of 3 months was applied in follow-up. Results Fifty-seven patients with paroxysmal AF and 13 patients with persistent AF were consecutively included. After an average of (14. 0±4. 3) cryoablation applica-tions,PV isolation was achieved in 274 of 282 (97. 2%) PVs. Procedural duration was(115. 2±24. 8) min and fluoroscopy time was(29. 6±8. 9)min. Real-time PVs potential recording during cryoablation was achieved in 232 (84. 3%) PVs. Regarding time to effect,a cut off value of 60 s was predictive of persistent PV isolation ( PVI) with a sensitivity of 0. 76 and specificity of 0. 82 ( area under curve=0. 835;P<0. 0001 ) . The overall complication rate was 2. 8% with two cases of transient hemoptysis and persistent phrenic nerve palsy,respec-tively. During a median follow-up of 5. 1 ( range 2. 2-14. 3 ) months, early recurrence was observed in 20 (28. 6%) patients. 76% of patients were free of AF recurrence with a blanking period of 3 months. Multivariate analysis showed that enlarged LA [hazard ratio(HR), 1. 41;95% confidence interval(CI), 1. 13-1. 75;P=0. 002],current smoking(HR 2. 44;95% CI, 1. 21-5. 67;P=0. 016) and early recurrence(HR 19. 3;95% CI,&nbsp;3. 87-96. 58;P<0. 001) were predictors of late recurrence. Conclusion Cryoablation is a feasible,safe and effective technique for the treatment of AF. PV potentials can be recorded in most PVs. The time to effect is pre-dictive of the persistency of PVI. Early recurrence significantly raises the risk of late recurrence.