| Objective: Atrial fibrillation(AF)is one of the most common arrhythmias,and the incidence of AF is getting higher and higher with aging.AF has close relationship with stroke,heart failure,decreased quality of life and increased mortality.Catheter ablation of AF has been proven as a effective therapy for rhythm control,and pulmonary vein isolation(PVI)is considered as the cornerstone of catheter ablation of AF.As known,radiofrequency catheter ablation is an effective way to treat AF,but the risks of cardiac tamponade,thromboembolism,pulmonary vein stenosis and other serious complications exist.The technique of point-by-point ablation,more complex manipulation of catheter,and longer learning curve have limited the development of radiofrequency catheter ablation.Clinical studies have shown that cyroballoon ablation has the advantages of high success rate,fewer complications,shorter operation time and easier operation compared with traditional radiofrequency catheter ablation.At present,there are no more clinical reports about the comparison between the first generation and the second generation of cryoballoons.The purpose of this study is to compare the effectiveness and safety between the first generation and the second generation of cryoballoons in the treatment of AF.Methods: This study retrospectively analyzed 250 patients with AF treated with cryoballoon ablation in the General Hospital of Shenyang Military Region from October 2015 to June 2017.The patients were divided into two groups,the first generation of cryoballoon group(Group A)and the second generation of cryoballoon group(Group B),The clinical baseline data,intraoperative related freezing parameters,perioperative period complications,and success rate were compared between the two groups.Results: There were 124 patients in Group A,80(64.5%)were male and 44(35.5%)were female,with an average age of 58.2 ± 9.1 years.There were 126 cases in Group B),77(61.1%)were male and 49 were women(38.9%),with average age of 59.5 ± 11.7 years.There were no differences between the 2 groups among the baseline clinical data,such as type of AF,diabetes,cerebral infarction,hypertension,left atrium diameter,left ventricular ejection fraction.The operation time and X-ray exposure time in Group B were significantly lower than that in Group A [(91.5 ± 33.6)min vs(99.2 ± 25.2)min,P = 0.041;(585.2 ± 379.5)m Gy vs(585.2 ± 379.5)m Gy,P <0.01;respectively].The lowest freezing temperature in the first generation of cryoballoon group was significantly higher than that in the second generation of cryoballoon group during ablation of the left superior pulmonary vein(-50.9 ± 6.4 vs-48.8 ± 5.4,P = 0.008),the left inferior pulmonary vein(-45.1 ± 5.9 vs-43.4 ± 4.8,P = 0.015)and the right superior pulmonary vein(-53.6 ± 6.4 vs-50.7 ± 5.6,P <0.001),but there was no difference in the right lower pulmonary vein(-46.1 ± 7.8 vs-46.7 ± 6.2,P = 0.52).Compared with the first generation cryoballoon group,the freezing time in the second generation cryoballoon group was significantly lower [the left superior pulmonary vein(360.4 ± 101.1 vs 558.8 ± 195.2s,P <0.01),the left inferior pulmonary vein(366.6± 86.4 vs 566.1 ± 163.1s,P <0.01),the right superior pulmonary vein(320.4 ±86.6 vs 456.7 ± 136.7s,P <0.01),the right inferior pulmonary vein(340.7 ± 78.7vs 486.4 ± 107.8,P <0.01)and the right middle pulmonary vein(225.0 ± 90.0 vs346.7 ± 115.3,P = 0.09).The incidence of vagal reflex in the second generation cryoballoon group was higher than that in the second generation cryoballoon group(35.8% vs 23.4%,P = 0.033).The time of PVI in the left superior pulmonary vein(52.3 ± 21.6s vs 76.5 ± 49.2s,P <0.01),the left inferior pulmonary vein(56.8 ± 30.7s vs 85.5 ± 48.6s,P <0.01)and the right superior pulmonary vein(42.8 ± 18.5s vs 61.2 ± 47.1 s,p <0.01)was significantly shorter in the second generation cryoballoon group than in the first generation cryoballoon group,but there was no difference in the right inferior pulmonary vein(53.6 ±33.7s vs 54.9 ± 34.3s,P>0.05).The temperature at the time of PVI in the left superior pulmonary vein(-34.5 ± 8.0℃ vs-38.4 ± 5.1℃,P <0.01),the left inferior pulmonary vein(31.2 ± 8.8℃ vs-34.9 ± 5.6,P > 0.05)and the right superior pulmonary vein(-34.4 ± 7.1℃ vs 30.8 ± 19.0℃,P <0.05)was significantly lower in the second generation cryoballoon group than in the first generation cryoballoon group,but there was no difference in the right inferior pulmonary vein(-30.6 ±13.3℃ vs-32.7 ± 8.9℃,P> 0.05).One case of phrenic nerve injury occurred in the second generation cryoballoon group,and two cases occurred in the first generation cryoballoon group(0.8% vs 0.4%,P = 0.552).There was no statistical significance.During follow-up,93 cases(74.4%)in the first generation cryoballoon group and 105 cases(84%)in the second generation cryoballoon group had no recurrence of AF(P <0.001).Conclusion: The second generation of cryoballoon ablation of atrial fibrillation has the advantages of shorter operation time,faster target temperature,higher success rate and less X-ray exposure compared with the first generation of cryoballoon ablation,but the incidence of vagal reflex is higher in the second generation cryoballoon group,consider the analysis may be with the second generation of frozen balloon temperature decreases faster,deeper tissue infiltration.Both the second and the first generation of cryoballoon are safe in catheter ablation of AF. |
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