| Objective: To investigate the efficacy and safety of cryoballoon ablation in the treatment of atrial fibrillation,and analyze the predictive value of clinical indicators and surgical parameters for postoperative recurrence.Methods: Patients with paroxysmal or persistent atrial fibrillation treated with 28 mm second-generation cryoballoon in the Department of Cardiovascular Medicine of the First Affiliated Hospital of China Medical University were included from August 2018 to December 2019.The clinical history,laboratory test and examination data of the patients were collected before the operation,and the surgical parameters of the patients were collected during the operation,including: each pulmonary vein was frozen for 30 s,60s and120 s as well as the minimum temperature,the accumulated times and times of freezing(the time of first freezing was 180s).Patients were followed up for recurrence by 12-lead ECG or 24-hour Holter ECG at 1,3,6 and 12 months after operation.According to the type of atrial fibrillation and whether there was recurrence after the operation,the difference between the two groups of patients was compared,and the independent risk factors for recurrence after cryoablation for atrial fibrillation were predicted by multifactor COX regression.The effectiveness endpoint of this study is whether atrial arrhythmia events are recorded after operation,and the safety endpoint is intraoperative and postoperative complications,such as phrenic nerve paralysis,cardiac tamponade and bleeding events.Results: A total of 179 patients(mean age 61.98 ± 8.96 years,male 56.4%,paroxysmal atrial fibrillation 148 patients(82.7%))who underwent second-generation cryoballoon ablation were included.There were significant differences between paroxysmal AF and persistent AF in hs-TNT,BNP,LAD and LVEF.The mean number of freezing cycles in the left superior pulmonary vein(LSPV),left inferior pulmonary vein(LIPV),right superior pulmonary vein(RSPV)and right inferior pulmonary vein(RIPV)were 2.26 ± 0.89,1.55± 0.68,1.78 ± 0.73 and 1.63 ± 0.91,respectively.There were statistical differences in the freezing temperature,times and time of each pulmonary vein at each time point(P < 0.001),among which RSPV had the lowest freezing temperature.5 patients had phrenic nerve palsy,1 had severe pulmonary vein stenosis,1 had severe femoral artery pseudoaneurysm and no pericardial tamponade.After a mean follow-up of 21.4 ± 5.0 months,128 patients(71.5%)had no postoperative AF recurrence,of which the success rate of paroxysmal AF was 73.0%,and the success rate of persistent AF was 64.5%.Baseline BNP,LVEF,and LSPV,LIPV,and RIPV temperatures were all statistically different between the AF-free group and the AF-recurrence group,and multivariate COX regression analysis showed that the risk factor for independently predicting AF recurrence was RIPV60 s temperature.When the RIPV60 s temperature cutoff was-40.5 ℃,the sensitivity for predicting AF recurrence was 34.4% and specificity was 82.4%.There was no statistical difference in the right pulmonary vein freezing temperature and frequency between the phrenic nerve palsy group and the non-paralysis group.Conclusion: The second-generation balloon cryoablation for atrial fibrillation was safe and effective,with a mean follow-up of 21.4 months.The surgical success rate was 71.5%,and the incidence of complications was low.The intraoperative parameters of cryotherapy could predict the success rate of atrial fibrillation surgery.The RIPV60 s temperature was the highest in predicting the success rate of atrial fibrillation ablation,but the single indicator was limited in predicting the recurrence of atrial fibrillation.The phrenic nerve paralysis was not related to the number of freezing times and temperature. |
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