Nonocclusive Ablation Technique Using a Novel Cryoballoon for Failed Left Superior Pulmonary Vein Isolation Despite Complete Occlusion.

IF 1.7 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Pace-Pacing and Clinical Electrophysiology Pub Date : 2025-02-01 Epub Date: 2025-01-05 DOI:10.1111/pace.15136

Kazuya Murata, Yasuteru Yamauchi, Yumi Yasui, Atsuhito Oda, Hirofumi Arai, Yuichiro Sagawa, Hideki Arima, Manabu Kurabayashi, Shinsuke Miyazaki, Tetsuo Sasano

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Abstract

Background: An indicator of successful cryoballoon (CB)-assisted pulmonary vein (PV) isolation is complete PV occlusion. However, CBs may exhibit a weaker freezing effect on the equatorial plane. This study investigates the predictors of failed left superior PV (LSPV) isolation despite complete occlusion with novel CBs.

Methods: This retrospective analysis enrolled 300 consecutive patients who underwent first-time ablation with POLARx or POLARxFIT between November 2021 and October 2023. Of the total, complete occlusion of the LSPV was achieved in 200 patients. Patients in whom LSPV isolation was achieved with additional nonocclusive freezing of the LSPV roof due to nonisolation of LSPV despite complete occlusion (Group A) were compared with those in whom isolation was achieved with complete PV occlusion alone (Group B).

Results: Group A had a larger LSPV diameter (21.5 ± 4.6 mm vs. 18.8 ± 3.3 mm, p = 0.052), larger left atrial volume on CT (142.3 ± 47.8 cc vs. 117.8 ± 39.0 cc, p = 0.028), higher nadir temperature (-54.1 ± 5.1°C vs. -60.2 ± 4.4°C, p < 0.001), and smaller northern latitude of the balloon contact site on the LSPV roof side (20.9° ± 3.8° vs. 38.9° ± 6.7°, p < 0.001) compared with Group B. A 27.5° north latitude was observed in most of Group A (sensitivity, 100%; specificity, 96%).

Conclusions: Adequate contact positioning of the northern hemisphere to the LSPV is critical for effective isolation, particularly when isolation is challenging despite complete occlusion. In such cases, nonocclusive cryoablation against the LSPV roof might be effective.

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新型低温球囊非闭塞消融技术在完全闭塞的情况下仍无法隔离左上肺静脉。

背景：低温球囊（CB）辅助肺静脉（PV）分离成功的一个指标是肺静脉完全闭塞。然而，CBs在赤道面可能表现出较弱的冻结效应。本研究探讨了新型CBs完全闭塞后左上PV （LSPV）分离失败的预测因素。方法：本回顾性分析纳入了300例连续患者，这些患者在2021年11月至2023年10月期间首次使用POLARx或POLARxFIT进行消融。其中，200例患者实现了LSPV完全闭塞。在LSPV完全闭塞后，由于LSPV未被隔离而对LSPV顶部进行额外的非闭塞性冷冻以实现LSPV分离的患者（A组）与仅通过完全PV闭塞实现LSPV分离的患者（B组）进行比较。A组LSPV直径更大（21.5±4.6 mm vs. 18.8±3.3 mm, p = 0.052）， CT上左心房容积更大（142.3±47.8 cc vs. 117.8±39.0 cc, p = 0.028），最低温度更高(-54.1±5.1°C vs. -60.2±4.4°C， p结论：北半球与LSPV的充分接触定位对于有效隔离至关重要，特别是在完全闭塞的情况下隔离具有挑战性。在这种情况下，对LSPV顶进行非闭塞性冷冻消融可能是有效的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pace-Pacing and Clinical Electrophysiology 医学-工程：生物医学

CiteScore

2.70

自引率

5.60%

发文量

209

审稿时长

2-4 weeks

期刊介绍： Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.