Dennis Lawin, Christoph Stellbrink, Kyoung-Ryul Julian Chun, Cheng-Hung Li, Kelly A van Bragt, Fred Kueffer, Jada M Selma, Il-Young Oh, Jean Manuel Herzet, Junichi Nitta, Ting Yung Chang, Thorsten Lawrenz
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引用次数: 0
Abstract
Aims: Early rhythm control therapy in atrial fibrillation (AF) results in higher freedom from atrial arrhythmia (AA) recurrence and improved cardiovascular outcomes. The optimal timing of cryoballoon ablation (CBA) is unknown.
Methods and results: We evaluated AA recurrence and procedure-related complications of early vs. late CBA (≤12 vs. >12 months from diagnosis) in patients enrolled in the prospective Cryo Global Registry (121 centres in 37 countries, NCT02752737). A total of 3447 subjects were followed through 12 months and 1220 through 24 months. In summary, 1573 patients (46%) had early ablation at a median (IQR) of 0.3 (0.1-0.6) years from AF diagnosis (age 62 ± 12 years., 35.8% female, 71.4% paroxysmal), and 1874 (54%) had late ablation at a median of 3.4 (1.9-6.7) years after diagnosis (age 61 ± 11 years, 36.2% female, 75.0% paroxysmal). Early ablation patients were less hypertensive (53.5% vs. 57.9%, P = 0.01) and less symptomatic (1.5 ± 1.1 vs. 1.8 ± 1.1 symptoms/patient, P < 0.01) and had smaller left atrial diameters (41 ± 7 mm vs. 42 ± 7 mm, P < 0.01). Freedom from AA recurrence was 81.5% (95% CI: 78.7-83.9%) in the early vs. 71.7% (95% CI: 68.9-74.3%) in the late ablation group at 24 months (P < 0.01). The risk of cardioversion was 41% lower in the early ablation group [HRAdj: 0.59 (0.42-0.83), P < 0.01]. Serious procedure-related adverse events occurred in 2.4 and 3.5% of patients in the early and late ablation groups (P = 0.045), respectively.
Conclusion: CBA within 12 months from AF diagnosis resulted in higher freedom from AA recurrence and is associated with fewer safety events in a real-world evaluation.
背景和目的：房颤（AF）的早期心律控制治疗可提高房颤（AA）复发的自由度，并改善心血管预后。低温球囊消融（CBA）的最佳时机尚不清楚。方法：我们在前瞻性冷冻全球注册中心（37个国家121个中心，NCT02752737）登记的患者中评估早期和晚期CBA的AA复发和手术相关并发症（诊断后12个月≤12和>）。结果：共有3447名受试者随访12个月，1220名受试者随访24个月。总之，1573例患者（46%）在房颤诊断后0.3[0.1-0.6]年（年龄62±12岁）进行了早期消融。（35.8%为女性，71.4%为阵发性），1874例（54%）在诊断后3.4[1.9-6.7]年（年龄61±11岁）进行了晚期消融。，女性36.2%，阵发性75.0%)。早期消融患者高血压较少（53.5% vs. 57.9%, p=0.01），症状较少（1.5±1.1 vs. 1.8±1.1个症状/患者）。结论：房颤诊断后12个月内的CBA可提高AA复发的自由度，并且在实际评估中与较少的安全性事件相关。临床试验注册：https://clinicaltrials.gov/ct2/show/NCT02752737 。
期刊介绍：
EP - Europace - European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology of the European Heart Rhythm Association of the European Society of Cardiology. The journal aims to provide an avenue of communication of top quality European and international original scientific work and reviews in the fields of Arrhythmias, Pacing and Cellular Electrophysiology. The Journal offers the reader a collection of contemporary original peer-reviewed papers, invited papers and editorial comments together with book reviews and correspondence.
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