The effect of cryoballoon ablation or radiofrequency ablation on left atrial remodeling in patient with paroxysmal atrial fibrillation
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摘要: 目的 比较冷冻球囊消融(CBA)与射频消融(RFA)对阵发性心房颤动(房颤)患者心房重构的影响。方法 本研究选取在2014年5月—2017年5月于郑州大学第一附属医院因阵发性房颤行CBA或RFA治疗的患者。所有患者均于术前、术后半年、1年、2年和3年时行12导联心电图或24 h动态心电图和超声心动图检查。左心房电重构通过P波离散度(Pdis)进行评估，结构重构通过左心房直径(LAD)和左心房容积指数(LAVI)评估。结果 共入选328例患者，经过倾向性评分法匹配后，CBA组和RFA组分别纳入96例患者。消融术后1年、2年和3年，CBA组与RFA组患者的Pdis、LAD和LAVI均较术前明显减小(P< 0.05)；且消融术后6个月、1年、2年和3年，CBA组患者的Pdis、LAD和LAVI均较RFA组更小(P< 0.05)。Logistic回归分析发现，患者消融术后1年时的ΔPdis、ΔLAD或ΔLAVI是房颤/心房扑动(房扑)发生的独立危险因素(OR=1.307，95%CI1.039~1.605，P=0.035；OR=1.301，95%CI1.089~1.522，P< 0.001；OR=1.879，95%CI1.711~1.963，P< 0.001)。结论 CBA和RFA均可有效改善阵发性房颤患者的左心房电重构和结构重构，且CBA组患者左心房逆重构可能较RFA组更明显。Abstract: Objective The purpose is to assess the effect of atrial remodeling in patients with paroxysmal AF after CBA and RFA.Methods We enrolled 328 patients who underwent CBA or RFA for refractory paroxysmal AF in May 2014-May 2017. Patients were asked to undergo a 12-lead electrocardiogram, a 24-h Holter monitor, and an echocardiogram and to provide their clinical history and symptoms at 6 months and 1, 2, and 3 years postprocedurally. Electrical remodeling of the left atrium was assessed by P wave dispersion(Pdis); structural remodeling was assessed by theleft atrium diameter(LAD) and left atrial volume index(LAVI) during scheduled visits.Results After propensity score matching, 96 patients were included in the CBA group, and 96 were included in the RFA group. As of January 2020, compared with baseline, at 1 year, 2 years and 3 years after ablation, the average changes in Pdis(ΔPdis), LAD(ΔLAD) and LAVI(ΔLAVI) were significant in both the CBA and RFA groups(P< 0.05). Six months after ablation, ΔPdis, ΔLAD and ΔLAVI were greater in the CBA group than in the RFA group(P< 0.05). A higher ΔPdis, ΔLAD or ΔLAVI at 1 year after ablation may increase atrial fibrillation/flutter-free survival.Conclusion Although CBA and RFA are both effective in left atrial electrical and structural reverse-remodeling in paroxysmal AF, CBA may outperform RFA six months after ablation.
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Key words:
- atrial fibrillation /
- atrial remodeling /
- cryoballoon ablation /
- radiofrequency ablation
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表 1 患者基线特征
Table 1. General data
X±S 项目 匹配前(PSM法) 匹配后(PSM法) RFA组(223例) CBA组(105例) P值 RFA组(96例) CBA组(96例) P值 年龄/岁 57.74±10.17 57.12±10.12 0.50 57.59±11.23 57.67±10.00 0.62 男/例(%) 143(54.3) 55(52.4) 0.63 48(50.0) 47(49.0) 0.69 BMI/(kg·m-2) 25.83±2.77 25.88±2.86 0.79 25.75±2.99 25.82±2.78 0.80 房颤持续时间/月 30.83±38.53 30.75±65.45 0.91 32.81±39.97 31.33±71.70 0.88 LAD/mm 37.25±6.51 37.12±5.80 0.91 37.25±6.51 37.11±6.04 0.90 Pdis/ms 44.17±11.90 43.64±11.57 0.83 44.16±13.32 44.24±11.76 0.97 LAVI /(mL·m-2) 39.44±8.18 39.63±8.50 0.85 39.32±7.04 39.52±7.58 0.88 CHA2DS2-VASc评分/例(%) 0分 77(34.5) 28(26.7) 0.15 32(33.3) 28(29.2) 0.53 1分 60(26.9) 41(39.0) 0.03 28(29.2) 37(38.5) 0.17 2分 42(18.8) 19(18.1) 0.87 18(18.8) 18(18.8) 1.00 3分 33(14.8) 15(14.3) 0.90 13(13.5) 11(11.5) 0.66 4分 9(4.0) 2(1.9) 0.51 5(5.2) 2(2.1) 0.44 5分 2(0.9) 0(0) 1.00 0(0) 0(0) 1.00 NYHA分级/例(%) 无心力衰竭 145(65.0) 85(81.0) 0.03 44(45.8) 36(37.5) 0.24 Ⅰ级 44(19.7) 11(10.5) 0.04 22(22.9) 26(27.1) 0.51 Ⅱ级 20(9.0) 8(7.6) 0.68 27(28.1) 32(33.3) 0.43 Ⅲ级 15(6.7) 4(3.8) 0.29 3(2.1) 2(3.1) 1.00 既往病史/例(%) 脑卒中/TIA 22(9.9) 13(12.4) 0.49 9(9.4) 12(12.5) 0.49 冠心病 66(29.6) 18(17.1) 0.02 23(24.0) 18(18.8) 0.38 高血压 99(44.4) 45(42.9) 0.79 44(45.8) 45(50.6) 0.89 T2DM 50(22.4) 17(16.2) 0.19 20(20.8) 16(16.7) 0.46 药物治疗/例(%) 抗心律失常药 148(66.4) 50(47.6) < 0.001 50(52.1) 46(47.9) 0.56 ACEI/ARB 95(42.6) 46(43.8) 0.84 42(43.8) 44(45.8) 0.77 β受体阻滞剂 99(44.4) 48(45.7) 0.82 47(49.0) 46(47.9) 0.89 NYHA：纽约心脏病学学会；TIA：短暂性脑缺血发作；T2DM：2型糖尿病；ACEI：血管紧张素转换酶抑制剂；ARB：血管紧张素受体抑制剂；CHA2DS2-VASc=(充血性心力衰竭，高血压，年龄≥75岁，糖尿病，脑卒中/TIA/血栓栓塞性疾病)-(血管疾病，年龄为65~74岁，女性)。 
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表 2 两组患者平均Pdis、LAD和LAVI的比较
Table 2. Pdis, LAD and LAVI
X±S 项目 Pdis/ms LAD/mm LAVI/(mL·m-2) CBA组(96例) RFA组(96例) CBA组(96例) RFA组(96例) CBA组(96例) RFA组(96例) 消融术前 44.24±11.76 44.16±13.32 37.11±6.04 37.25±6.51 39.52±7.58 39.32±7.04 消融术后6个月 35.20±9.24 39.83±13.782) 35.33±4.84 37.46±6.062) 36.24±7.54 38.06±8.872) 消融术后1年 34.81±13.471) 38.43±15.701)2) 34.72±5.931) 35.06±5.931)2) 34.52±8.621) 35.77±9.381)2) 消融术后2年 30.48±10.841) 35.60±14.171)2) 32.68±4.591) 33.18±5.681)2) 31.74±7.761) 33.48±8.751)2) 消融术后3年 29.09±13.401) 33.86±15.541)2) 30.11±3.661) 31.64±4.641)2) 30.27±10.081) 31.02±12.181)2) 与消融术前比较，1)P < 0.05；与CBA组比较，2)P < 0.05。
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表 3 两组患者ΔPdis、ΔLAD和ΔLAVI的比较
Table 3. ΔPdis, ΔLAD and ΔLAVI
X±S 项目 ΔPdis/ms ΔLAD/mm ΔLAVI/(mL·m-2) CBA组(96例) RFA组(96例) CBA组(96例) RFA组(96例) CBA组(96例) RFA组(96例) 消融术后6个月 6.45±8.31 2.22±7.631) 1.76±2.36 0.56±1.911) 3.56±4.73 1.23±3.661) 消融术后1年 9.15±11.10 5.54±9.48 2.49±3.28 1.85±2.96 4.99±5.47 3.55±5.56 消融术后2年 11.82±12.97 8.00±13.39 3.67±5.30 3.27±2.90 7.68±7.78 6.29±6.65 消融术后3年 12.36±14.14 8.25±12.24 4.22±3.53 4.03±3.16 8.85±11.09 8.14±8.50 与CBA组比较，1)P < 0.05。
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