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2011年医学研究热点：冷冻球囊治疗心房颤动研究动态
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冰冻法让心房颤动病人重获“心”生
美国心脏协会表示，全美有220万人饱受心房颤动之苦，心房颤动可能导致病患疲劳、呼吸短促甚至中风。不过，一种可以将心脏组织冰冻的设备会让他们脱离苦海。
2010年12月，美国食品和药物管理局（FDA）批准了心脏电子医疗设备制造商美敦力公司的冷冻球囊用于阵发性房颤的治疗。据了解，冷冻球囊治疗主要是将球囊放在左心房肺静脉出口，再将冷冻剂充满球囊，破坏肺静脉出口组织而达到治疗房颤效果。
Atrial fibrillation and freezes heart
Right ventricular rapid pacing in catheter ablation of atrial fibrillation: a novel application for cryoballoon pulmonary vein isolation.
Authors: Chun, K R, Fürnkranz, A, Schmidt, B, Metzner, A, Tilz, R, Zerm, T, Köster, I, Koektuerk, B, Konstantinidou, M, Ouyang, F, Kuck, K H
Journal: Clinical research in cardiology : official journal of the German Cardiac Society, Vol. 98 (8): 493-500, 2009
Abstract: BACKGROUND: Cryoballoon ablation (Arctic Front, Cryocath) represents a novel technology for pulmonary vein isolation (PVI). The initial phase of a freeze is crucial for cryolesion formation which is determined by local temperature depending on blood flow. We investigated the impact of right ventricular rapid pacing (RVRP) on temperature kinetics in patients (pts) with paroxysmal atrial fibrillation (PAF). METHODS AND RESULTS: Right ventricular rapid pacing was performed from the RV apex. Absolute minimal temperature (MT, degrees C), temperature slopes [time (s) to 80% MT; dT/dt), area under the curve (AUC) and arterial blood pressure (ABP, mmHg) were compared (group I: with RVRP vs. group II: without RVRP). RVRP (mean duration 55 +/- 7 s) was performed in 11 consecutive PAF pts (41 PVs, age 58 +/- 9 years, LA size 44 +/- 6 mm, normal ejection fraction). Only freezes with identical balloon positions were analyzed (11/41 PVs). RVRP (cycle length 333 +/- 3 ms) induced a significant drop in ABP (group I: 45 +/- 3 mmHg vs. group II: 100 +/- 18 mmHg, p < 0.001). MT was not different between group I and group II (-45.0 +/- 4.4 vs. -44.3 +/- 3.4 degrees C, p = 0.46), whereas slope (38.0 +/- 4.6 s vs. 51.6 +/- 14.4 s, p = 0.0034) and AUC (1090 +/- 4.6 vs. 1181 +/- 111.2, p = 0.02) was significantly changed. In one pt, a ventricular tachycardia was induced. PVI was achieved in 41/41 PVs. CONCLUSION: Right ventricular rapid pacing significantly accelerates cryoballoon cooling during the initial phase of a freeze possibly suggesting improved cryolesions.
Affiliation: Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany. jongichun@t-online.de
Pubmed MeSH: Aged, Atrial Fibrillation, Balloon Dilatation, Cardiac Pacing, Artificial, Combined Modality Therapy, Cryosurgery, Female, Heart Conduction System, Heart Rate, Heart Ventricles, Humans, Male, Middle Aged, Pulmonary Veins, Treatment Outcome
Wikipedia: AUC, Acceleration, Area under curve, Arteries, Artery, Atrial Fibrillation, Auricular Fibrillation, Blood Pressure, Cannula, Cannulation, Catheter, Catheter ablation, Catheterization, Client, Diastolic pressure, Fibril, Freezing, Industrial Arts, Kinetic, MT1, MT 1, Methanol-5-hydroxybenzimidazolylcobamide Co-methyltransferase, Mtab, Patient, Pressure, Pulmonary Vein, Pulse pressure, Systolic pressure, Tachyarrhythmia, Tachycardia, Tachycardia, ventricular, Technology, Temperature, Ventricular tachycardia
Title: Acute and long-term efficacy and safety of catheter cryoablation of the cavotricuspid isthmus for treatment of type 1 atrial flutter.
Authors: Feld, G K, Daubert, J P, Weiss, R, Miles, W M, Pelkey, W, Cryoablation Atrial Flutter Efficacy Trial Investigators
Abstract: BACKGROUND: Atrial flutter (AFL) is commonly treated by radiofrequency catheter ablation. Catheter-based cryoablation may be an effective alternative with potential advantages. OBJECTIVE: The purpose of this study was to study the acute and long-term safety and efficacy of catheter-based cryoablation for treatment of cavotricuspid isthmus-dependent (typical and reverse typical) AFL. METHODS: Catheter-based cryoablation was performed with a 10Fr catheter in 160 patients with cavotricuspid isthmus-dependent AFL (122 men and 38 women; mean age 63.1 +/- 9.3 years, mean left ventricular ejection fraction 54.6% +/- 10.4%); 94 (58.8%) of these patients also had atrial fibrillation (AF). All patients underwent right atrial (RA) activation mapping and pacing at the cavotricuspid isthmus to demonstrate concealed entrainment and confirm cavotricuspid isthmus dependence of AFL. Catheter-based cryoablation of the cavotricuspid isthmus was performed with multiple freezes (average freeze time 2.3 +/- 0.5 minutes) until bidirectional block was demonstrated during pacing from the low lateral RA and coronary sinus, respectively. Patients were evaluated at 1, 3, and 6 months and underwent weekly and symptomatic event monitoring. Acute procedural success was defined as cavotricuspid isthmus block persisting 30 minutes after ablation. Long-term success was defined as absence of AFL during follow-up. RESULTS: Acute success was achieved in 140 (87.5%) of 160 patients. Total procedure time was 200 +/- 71 minutes, ablation time (including a 30-minute waiting period after ablation) was 139 +/- 62 minutes, and fluoroscopy time was 35 +/- 26 minutes. An average of 20.5 +/- 11.3 freezes, for a total ablation time of 47.4 +/- 24.3 minutes, were required to achieve cavotricuspid isthmus block, with average and nadir temperatures of -81.5 degrees C +/- 3.7 degrees C and -85.6 degrees +/- 3.6 degrees C, respectively. Four patients (2.5%) had procedure-related adverse events. Of 132 patients with acute efficacy who completed 6-month follow-up, 8 (6%) were lost to follow-up or were noncompliant with event recordings. Using survival analysis, 106 (80.3%) remained free of AFL on strict analysis of event recordings only, and 119 (90.2%) remained clinically free of AFL. CONCLUSION: This large pivotal study demonstrated the acute and long-term efficacy and safety of catheter-based cryoablation for cavotricuspid isthmus-dependent AFL, similar to rates previously reported for radiofrequency catheter ablation.
Affiliation: Department of Medicine, Division of Cardiology, University of California, San Diego, California 92103, USA. gfeld@ucsd.edu
Pubmed MeSH: Aged, Atrial Flutter, Cardiac Pacing, Artificial, Catheter Ablation, Cryosurgery, Female, Humans, Male, Middle Aged, Stroke Volume, Time Factors, Treatment Outcome, Tricuspid Valve
Wikipedia: Atrial Fibrillation, Atrial Flutter, Auricular Fibrillation, Cannula, Cannulation, Catheter, Catheter ablation, Catheterization, Client, Coronary Sinus, Critique, Cryoablation, Cryosurgery, Evaluation, Evaluation research, Fluoroscopy, Free Will, Freezing, Men, Methods, Nonoxynol, Nonoxynol-9, Patient, Patient's Rights, Patient rights, Patients' Rights, Personal autonomy, Procedure, Safety, Self Determination, Stroke Volume, Survival Analysis, Temperature, Woman, Women
https://blog.sciencenet.cn/blog-280034-405798.html
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