Clinical Observation Of The Application Of Second-generation Cryoballoon Catheter Ablation In The Treatment Of Non-valvular Atrial Fibrillation

1.BackgroundAtrial fibrillation(AF)refers to the lack of regular electrical activity of the atrium,replaced by rapid and disordered atrial fibrillation waves,which is the most common persistent arrhythmia in clinic.With the increasing prevalence of AF,the risk of complications such as thromboembolism,heart failure and sudden death increases exponentially.Because of its high disability and mortality,it seriously affects the quality of life of patients and has become one of the most important public health problems in the 21 century.The treatment of AF is a major factor affecting the prognosis of AF.At present,the treatment of AF mainly includes heart rate control,rhythm control and antithrombotic/coagulation therapy.With the continuous maturity and improvement of radiofrequency catheter ablation(RFCA)technology,RFCA has been proved to be more effective than antiarrhythmic drugs in maintaining sinus rhythm and reducing recurrence rate,and there is no significant difference in the incidence of complications between antiarrhythmic drugs and RFCA.RFCA has been recognized as a first-line treatment for patients with drug-refractory AF,especially in patients with paroxysmal AF.However,due to the complexity of RFCA,its long learning curve and the incidence of serious operative complicationssuch as cardiac perforation,thromboembolism and pulmonary vein stenosis,it is difficult to be widely used.Since most AF triggers originate from the muscle cuff in the pulmonary vein,complete circumferential pulmonary vein isolation(CPVI)is the cornerstone of AF radiofrequency ablation.The 2016 FIRE AND ICE study confirmed that cryoballoon catheter ablation(CBCA)is as safe and effective as radiofrequency catheter ablation with cold saline perfusion in the treatment of paroxysmal atrial fibrillation(ParAF).In addition,compared with RFCA,CBCA with a short learning curve,is relatively simple and easy to be mastered by electrophysiologists,which is conducive to the popularization of the treatment,but there is still the problem of postoperative recurrence in a part of patients.At present,the risk factors for recurrence of NVAF after CBCA are not completely clear.2.ObjectiveTo analyze the efficacy and safety of second generation CBCA in the treatment of non-valvular atrial fibrillation(NVAF)and the risk factors for recurrence of NVAF after CBCA.3.Objects and Methods(1)objects:A total of 47 NVAF patients who underwent second-generation CBCA in our hospital were selected from the patients who were hospitalized in the cardiovascular department of our hospital from January 2017 to January 2019 through the inclusion criteria and exclusion criteria.(2)methods:1.The clinical baseline data such as sex,age,height,weight,basic medical history,AF history and examination results,as well as operation time,fluoroscopy exposure,cryoablation temperature and complications were recorded in detail.2.During the follow-up period,the postoperative complications,recurrence results,secondary operation results and ECG results etc were collected to analyze the safety,success rate and risk factors for recurrence of NVAF after CBCA.4.Results(1)Among the 47 patients diagnosed as NVAF,there were 28 males(59.6%)and 19 females(40.4%).The average age was 65.34±9.82 years.The operative complications included right phrenic nerve paralysis in 1 case(2,12%),a small amount of pericardial effusion in 2 cases(4.25%),right inguinal hematoma in 1 case(2.12%).No pericardial tamponade,atrioesophageal fistula,pulmonary vein stenosis and other serious complications and perioperative death occurred.The average follow-up time was 21.02±8.47 months,33 patients(70.21%)maintained sinus rhythm during the follow-up period.Multivariate COX regression analysis showed that chronic heart failure(HR=3.566,95%CI:1.100?11.562,P=0.034)and BMI>24(HR=6.979,95%CI:1.511-32.242,P=0.013)were independent risk factors for recurrence of NVAF after CBCA.5.Conclusions(1)The second generation CBCA has good safety and efficacy in the treatment of NVAF.(2)Chronic heart failure and overweight are independent risk factors for recurrence of NVAF after CBCA.