Europace：房颤冷冻球囊消融术后房速发生的临床特征

自从心房颤动肺动脉触发学说被证实以来，越来越多的房颤患者通过环肺静脉隔离技术根治了房颤，然而目前环肺静脉射频消融技术采用逐点消融，其消融的成功率很大程度上取决于操作者的经验，而且非透壁的射频消融是术后发生房速的主要危险因素。因此近年来一些“单次”消融技术应用于临床，冷冻球囊消融术是其中之一，它被广泛应用于阵发性房颤的消融，其短期及中期消融的成功率不低于传统的射频消融术，然而关于冷冻球囊消融术后房速的发生率及其临床特征目前还没有报道。

据此Mikhaylov EN等进行了一项临床研究，近来发表于Europace杂志上，该研究旨在探讨冷冻球囊消融房颤后房性心动过速的发生率、临床特征及其预测因素。该研究共入选181例首次进行冷冻消融术的阵发性房颤患者，所有患者与消融术前及术后3个月植入事件记录仪，记录1个月的心电活动，然后每3个月进行一次Holter检查，平均随访时间为497.9天。

结果显示：175例患者完成了随访，14例患者发生了房性心动过速，其发生率8%，多因素Logistic回归分析提示多余的右肺静脉、使用B-阻滞剂、消融术前存在房速是患者发生房速的独立预测因素。7例患者进行了再次消融，占4%,结果显示两例患者房速起源于肺静脉心房再连接，其他患者未诱发出左房房速，所有患者均未发生左房大折返性房速。这些患者进行再次消融后未再发作房速。

通过该项研究可得出以下结论：冷冻球囊消融后左房房速的发生率较低，没有发现左房大折返性房速。房速发生的独立预测因子包括：多余的右肺静脉、消融术前存在房速、使用过β阻滞剂。

Regular atrial tachycardias developing after cryoballoon pulmonary vein isolation: incidence, characteristics, and predictors.
Abstract
AIMS: Cryoballoon ablation (CBA) is a well-used technique when performing pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF). Our aim is to describe incidence, characteristics, and clinical predictors for developing atrial tachycardias (ATs) after cryoballoon PV isolation in patients with paroxysmal AF.METHODS AND RESULTS: The study population consisted of 181 consecutive patients undergoing a first CBA. All patients received an event-recorder before cryoablation and transmitted daily electrocardiogram (ECG) during 1 month before ablation and 3 months after. Further follow-up consisted of 24 h Holter monitoring and ECG registration every 3 months and also in patients presenting with symptoms. A mean follow-up period was 497.9 ± 283.9 days, and 175 patients completed follow-up. In 14 (8%) patients regular ATs were registered. In multivariate logistic regression model, the following parameters were independently associated with ATs after ablation: an additional right PV, treatment with beta-blockers, and presence of AT on event-recording strips before ablation. Seven (4%) patients with registered AT underwent a redo procedure. In two (1.1%) patients ATs were originated in reconnected PVs. In other patients no left AT was induced. No macro re-entrant left AT was documented in any patient. During follow-up, after a redo ablation, no AT was registered.CONCLUSION: The incidence of left AT after CBA is low, and no left atrial macro re-entrant tachycardia was found. The following independent predictors of AT development have been identified: an additional right PV, regular AT registered before ablation, and the use of beta-blockers.