用于冷冻球囊肺静脉隔离至大肺静脉的非闭塞性单独冷冻

Non-Occlusive Separate Freezing for Cryoballoon Pulmonary Vein Isolation to the Large Pulmonary Vein.

作者信息

Arai Hirofumi, Sagawa Yuichiro, Shigeta Takatoshi, Murata Kazuya, Sudo Koji, Yasui Yumi, Oda Atsuhito, Kurabayashi Manabu, Okishige Kaoru, Sasano Tetsuo, Yamauchi Yasuteru

机构信息

Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan.

Department of Cardiovascular Medicine, Institute of Science Tokyo, Tokyo, Japan.

出版信息

Pacing Clin Electrophysiol. 2025 Aug 2. doi: 10.1111/pace.70025.

DOI:10.1111/pace.70025

PMID:40751488

Abstract

BACKGROUND

Cryoballoon pulmonary vein (PV) isolation (PVI) requires PV occlusion, which can be challenging to the large PV. The non-occlusive separate freezing, which involves freezing the superior and inferior portions of the PV ostium without complete occlusion, is often useful in these situations. This study aimed to evaluate the efficacy and long-term results of the non-occlusive separate freezing technique and compare the treatment details of POLARx and Arctic Front Advance Pro (AFA-Pro).

METHODS

Patients who underwent cryoballoon PVI using the non-occlusive separate freezing between September 2019 and April 2023 in our institution were analyzed and followed up for 1 year. Success rates of PVI by non-occlusive separate freezing and treatment outcomes were compared between POLARx and AFA-Pro. The 1-year arrhythmia-free survival was also evaluated.

RESULTS

Overall, 135 PVs were analyzed (POLARx, n = 63; and AFA-Pro, n = 72). The success rates of PVI for the POLARx and AFA-Pro were 55/63 (87.3%) and 52/72 (72.2%), p = 0.04. The nadir temperatures for the POLARx and AFA-Pro were -52.2 ± 4.7°C and -42.4 ± 7.4°C, p < 0.001. No phrenic nerve injury occurred in either group, but two cases of gastric hypomotility were observed using POLARx. The 1-year arrhythmia-free survival rates for POLARx and AFA-Pro were 86.4% and 81.2%, p = 0.47.

CONCLUSIONS

The success rate of PVI using the non-occlusive separate freezing technique was approximately 80% and was significantly higher with POLARx than with AFA-Pro. The 1-year arrhythmia-free survival rate was not significantly different.

摘要

背景

冷冻球囊肺静脉（PV）隔离术（PVI）需要闭塞肺静脉，这对于较大的肺静脉可能具有挑战性。非闭塞性分区域冷冻，即对肺静脉口的上部和下部进行冷冻而不完全闭塞，在这些情况下通常很有用。本研究旨在评估非闭塞性分区域冷冻技术的疗效和长期结果，并比较POLARx和北极锋Advance Pro（AFA-Pro）的治疗细节。

方法

对2019年9月至2023年4月在我院接受非闭塞性分区域冷冻球囊PVI的患者进行分析，并随访1年。比较POLARx和AFA-Pro采用非闭塞性分区域冷冻进行PVI的成功率和治疗结果。还评估了1年无心律失常生存率。

结果

总体上，分析了135条肺静脉（POLARx组63条；AFA-Pro组72条）。POLARx和AFA-Pro的PVI成功率分别为55/63（87.3%）和52/72（72.2%），p = 0.04。POLARx和AFA-Pro的最低温度分别为-52.2±4.7°C和-42.4±7.4°C，p < 0.001。两组均未发生膈神经损伤，但使用POLARx观察到2例胃动力不足。POLARx和AFA-Pro的1年无心律失常生存率分别为86.4%和81.2%，p = 0.47。