超重和肥胖对冷冻球囊和脉冲场消融术肺静脉隔离术患者辐射剂量和疗效的影响

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2024-10-01 DOI:10.1016/j.ijcha.2024.101516

Christiane Jungen , Manuel Rattka , Jan Bohnen , Evangelos Mavrakis , Dimitra Vlachopoulou , Sebastian Dorna , Isabel Rudolph , Christina Kohn , Dobromir Dobrev , Tienush Rassaf , Shibu Mathew

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引用次数: 0

摘要

背景使用脉冲场消融（PFA）或冷冻球囊消融（CBA）进行肺静脉隔离（PVI）是治疗心房颤动（AF）患者的常用单次技术。接受 PVI 治疗的超重（BMI 25-30 kg/m2）和肥胖（BMI>30 kg/m2）患者人数正在增加，但有关这一患者群体的数据却很有限。方法本回顾性分析纳入了 BMI ≥25 kg/m2 且接受 PFA 或 CBA-PVI 治疗的连续房颤患者。结果115名患者（66%为男性，64岁[IQR：58-71岁]，57%超重，43%肥胖）中，68%接受了PFA-，32%接受了CBA-PVI。造影剂用量（PFA：80 毫升 [IQR: 60 - 117 毫升] vs. CBA：130 毫升 [IQR: 95 - 200 毫升]，P=0.001）和辐射量（PFA：2196 cGy-cm2 [IQR: 1398 - 2973 cGy-cm2] vs. CBA：PFA-PVI患者的辐射量（PFA：2196 cGy-cm2 [IQR: 1398 - 2973 cGy-cm2] vs CBA：3239 cGy-cm2 [IQR: 1288 - 5062 cGy-cm2], P=0.009）更低。逻辑回归分析发现，肥胖（OR：5.58，95 % CI：1.63-19.06；P=0.006）和CBA-PVI（OR：12.93，95 % CI：3.51-47.68；P<0.001）与辐照增加有关。两种技术的安全性相当（PFA：4% vs. CBA：0%；P=0.3）。中位随访时间为 145 天 [IQR: 103 - 294 天]。超重患者（82%）和肥胖患者（67%）（HR：0.61；95 % CI：0.29-1.28；P=0.19）以及 PFA-PVI 和 CBA-PVI 患者（76% vs. 76%，HR：1.37；95 % CI：0.63-2.99；P=0.42）1 年后的房颤恢复情况相似。肥胖与辐射暴露增加有关。两种技术的安全性相当。超重和肥胖患者的 1 年房颤自由度相似。

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Impact of overweight and obesity on radiation dose and outcome in patients undergoing pulmonary vein isolation by cryoballoon and pulsed field ablation

Background

Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) or cryoballoon ablation (CBA) are commonly used single-shot techniques for the treatment of patients with atrial fibrillation (AF). The number of overweight (BMI 25–30 kg/m²) and obese (BMI>30 kg/m²) patients undergoing PVI is increasing, but data on this patient population is limited.

Methods

Consecutive AF patients with a BMI ≥25 kg/m² undergoing PFA- or CBA-PVI were included in this retrospective analysis. Baseline characteristics, procedural parameters and 1-year AF-freedom were retrospectively analyzed and compared for both ablation modalities.

Results

Of 115 patients (66 % men, 64 years [IQR: 58–71 years], 57 % overweight and 43 % obese) PFA- was performed in 68 % and CBA-PVI in 32 %. Contrast-dye volume (PFA: 80 ml [IQR: 60 − 117 ml] vs. CBA: 130 ml [IQR: 95 − 200 ml], P=0.001) and radiation exposure (PFA: 2196 cGy·cm² [IQR: 1398 − 2973 cGy·cm²] vs. CBA: 3239 cGy·cm² [IQR: 1288 − 5062 cGy·cm²], P=0.009) was lower in patients undergoing PFA-PVI. Logistic regression analysis identified obesity (OR: 5.58, 95 % CI: 1.63–19.06; P=0.006) and CBA-PVI (OR: 12.93, 95 % CI: 3.51–47.68; P<0.001) to be associated with increased radiation exposure. Both techniques were comparably safe (PFA: 4 % vs. CBA: 0 %; P=0.3). The median follow-up time was 145 days [IQR: 103 − 294 days]. AF-freedom after 1-year was similar in overweight (82 %) and obese patients (67 %) (HR: 0.61; 95 % CI: 0.29–1.28; P=0.19) as well as in PFA- and CBA-PVI patients (76 % vs. 76 %, HR: 1.37; 95 % CI: 0.63–2.99; P=0.42).

Conclusion

Overweight and obese patients undergoing PFA-PVI had lower contrast-dye volume compared to CBA-PVI. Obesity was associated with increased radiation exposure. Both techniques were comparably safe. The 1-year AF-freedom was similar in overweight and obese patients.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.