Pitvarfi brilláció kezelése a pulmonalis vénák krioballon-izolációjával: Középtávú eredmények az első 55 beteg alapján

A pitvarfi brillacio transzkateteres kezelesere szamos radiofrekvencias hőablation alapulo technikat dolgoztak ki az utobbi 10 ev soran. Ujabban a fagyasztassal, a pulmonalis venak krioballonos izolalasaval elert eredmenyek a radiofrekvencias technikakehoz hasonlo hatekonysagot mutatnak az eletet leginkabb veszelyeztető szovődmenyek csokkenese mellett. Dolgozatunkban sajat eredmenyeinkről szamolunk be a mintegy egy ev alatt vegzett krioballon-ablatio alapjan az első 55 betegen. Modszer: a beavatkozast panaszos, gyogyszerrefrakter, tobbnyire paroxysmalisan pitvarfi brillalo betegeken vegeztuk, akiknek lenyeges szervi szivbaja nem volt. Minden esetben az osszes pulmonalis vena felkeresesere es izolalasara torekedtunk 28 mm atmerőjű, dupla falu ballonkateter hasznalataval, ami a pulmonalis venaszajadek kozeleben felfujva a kerulete menten a bal pitvari szovetet akar –70 Celsius-fokig hűtve megszunteti annak elektromos aktivitasat. A beavatkozas alatt heparint, utana oralis antikoagulanst alkalmaztunk. A fel eves utankovetes soran EKG-t, 24 oras EKG-Holtert es transztelefonos EKG-monitort hasznaltunk a ritmus monitorozasara. Eredmenyek: 55 betegen (18 nő; eletkor 56±33,64 ev) 192 pulmonalis vena kozul 165 (86%) izolaciojat sikerult elernunk a beavatkozas soran. Valamenynyi pulmonalis venat 37 betegben (67%) sikerult izolalni. A beavatkozasi idő 155,67±100,66 perc (atlag±SD), az atvilagitasi idő 34,04±31,89 perc volt. A 6 honapos utankovetesnel 34 beteg kozul 24-nel (70 %) sikerult teljes aritmiamentesseget (17 beteg) vagy a ritmuszavar szignifi kans csokkeneset (7 beteg) elernunk. Kovetkeztetesek: kezdeti tapasztalataink alapjan a krioballonos pulmonalis venaizolalas a radiofrekvencias ablational egyszerűbb modszer, ahhoz hasonlo eredmenyesseggel a pitvarfi brillacio kezelesere. Kulcsszavak: pitvarfi brillacio, krioballon-ablatio, pulmonalis vena Cryoballon isolation of the pulmonary veins in atrial fi brillation: Mid-term results after the fi rst 55 patients Several transcatheter techniques based on radiofrequency energy were elaborated for the treatment of atrial fi brillation through the last decade. Recently, similar success rates with a better safety profi le concerning life threatening complications were reported with the novel methode of cryoballon isolation of the pulmonary veins. This paper summarizes our initial experience with cryoballon ablation after the fi rst 55 patients. Methode: Symptomatic patients refractory to aniarrhythmic medication mostly with paroxysmal atrial fi brillation without signifi cant structural heart disease were enrolled. Cannulation and isolation of all pulmonary veins were attempted using a 28 mm double-wall cryoballon infl ated at the ostium of the vein and abolishing eletrical activity of atrial tissue around its perimeter by freezing to –70 C. Intravenous heparin during and oral anticoagulant after the procedure was administered. Conventional ECGs, Holter ECGs and transtelephonic ECG recordings were used through 6 months follow-up for rhythm monitoring. Results: In 55 patients enrolled (18 female; age: 56±33,64 years) 165 out ot 192 (86%) pulmonary veins were successfully isolated. All pulmonary veins were isolated in 37 patients (67%). Procedure time was 155.67±100.66 min, while fl uoroscopy time was 34.04±31.89 min. In 34 patients with 6 months follow-up 24 (70%) either remained free of arrhythmia (17 patients) or had a signifi cant decrease in arrhythmia burden (7 patients). Conclusion: Based on our initial experience, cryoballon isolation of pulmonary veins appears to be a more simple procedure with similar effi cacy to radiofrequency ablation in the treatment of atrial fi brillation.