背景:心房颤动(AF)消融术在控制心律方面越来越有效,但存在食管瘘等风险。最小化食管热损伤,同时简化程序是至关重要的。
方法:这项前瞻性研究涉及100名连续房颤患者,这些患者在简化镇静的情况下接受冷冻球囊消融术。没有食道温度监测。阵发性房颤患者(A组)仅接受肺静脉隔离,而持续性房颤患者(B组)也进行了左房顶消融.术后进行胃食管内镜检查以检测病变,在3,12和24个月时进行了心脏随访.
结果:该队列包括69%的男性,平均年龄为65.5岁。92例患者进行了消融术后内镜检查;A组为1.1%,B组为14%的患者未诊断为GERD,组间均匀分布,与病变发生无关。在16%的患者中观察到胃动力不足,组间无显著差异。24个月时,无心律失常生存率A组为88%,B组为74%。
结论:冷冻球囊辅助肺静脉隔离,在简化的镇静策略期间,有或没有额外的左房顶消融,并且没有食道温度监测,显示食管热损伤的低风险和有效的消融结果。
BACKGROUND: Atrial fibrillation (AF)
ablation is increasingly effective for managing heart rhythm but poses risks like esophageal fistulas. Minimizing esophageal thermal lesions while simplifying procedures is crucial.
METHODS: This prospective study involved 100 consecutive AF patients undergoing cryoballoon
ablation with simplified sedation, without esophageal temperature monitoring. Patients with paroxysmal AF (Group A) received pulmonary vein isolation only, while those with persistent AF (Group B) also had left atrial roof
ablation. Gastroesophageal endoscopy was performed post-procedure to detect lesions, and cardiological follow-ups were conducted at 3, 12, and 24 months.
RESULTS: The cohort included 69% men, with a median age of 65.5 years. Post-
ablation endoscopy was performed in 92 patients; esophageal lesions were found in 1.1% of Group A and none of Group B. GERD was diagnosed in 14% of patients, evenly distributed between groups and not linked to lesion occurrence. Gastric hypomotility was observed in 16% of patients, with no significant difference between groups. At 24 months, arrhythmia-free survival was 88% in Group A and 74% in Group B.
CONCLUSIONS: Cryoballoon-assisted pulmonary vein isolation, with or without additional left atrial roof
ablation and without esophageal temperature monitoring during a simplified sedation strategy, shows low risk of esophageal thermal injury and effective ablation outcomes.