Логотип НМИЦССХ им. А.Н. Бакулева Журнал «Новости сердечно-сосудистой хирургии»





2020; 4 (1): 1–72 

Роль криобаллонной изоляции легочных вен в лечении больных с фибрилляцией предсердий

Авторы: Ступаков С.И., Тарашвили Э.Г., Яхьяев Я.Б.

Организация:
ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» (президент – академик РАН и РАМН Л.А. Бокерия) Минздрава России, Рублевское ш., 135, Москва, 121552, Российская Федерация

Для корреспонденции: Сведения доступны для зарегистрированных пользователей.

Раздел: Обзоры

DOI: https://doi.org/10.24022/2588-0284-2020-4-1-5-11

УДК: 616.125

Библиографическая ссылка: Новости сердечно-сосудистой хирургии. 2020; (4): 5-11

Цитировать как: Ступаков С.И., Тарашвили Э.Г., Яхьяев Я.Б. . Роль криобаллонной изоляции легочных вен в лечении больных с фибрилляцией предсердий. Новости сердечно-сосудистой хирургии. 2020; (4): 5-11. DOI: 10.24022/2588-0284-2020-4-1-5-11

Ключевые слова: фибрилляция предсердий, криобаллонная изоляция легочных вен, радиочастотная изоляция легочных вен

Полнотекстовая версия:  

Аннотация

Фибрилляция предсердий (ФП) на сегодняшний момент – один из самых распространенных видов аритмии. По некоторым данным, в популяции развитых стран она встречается на миллион населения в 21 случае среди мужчин, в 12 случаях – среди женщин. В настоящее время наиболее часто применяемым и стандартным методом лечения ФП является радиочастотная (катетерная) аблация. Наиболее важный этап в лечении ФП методом катетерной аблации – радиочастотная изоляция легочных вен. Помимо радиочастотной аблации для успешной изоляции легочных вен используют баллонную криоаблацию. При контактировании криобаллона с тканью происходит вымораживание этого участка ткани с замещением миокардиальной ткани на фиброзную. Криобаллонная изоляция легочных вен по клинической эффективности не уступает радиочастотным методам изоляции легочных вен и может быть использована в качестве первичного хирургического метода для лечения ФП. Отдаленные результаты по оценке сохранности изоляции вен, как в эксперименте, так и в клинике, продемонстрировали высокую эффективность в плане отсутствия электрической активности в легочных венах. Наилучшие результаты получены при лечении пациентов с пароксизмальной формой ФП, однако метод оправдан и у пациентов с персистирующей и длительно персистирующей формами ФП, хотя и с меньшим эффектом. Таким образом, криобаллонная изоляция является равноценной альтернативой радиочастотным методам лечения ФП.

Литература

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  1. Chugh S.S., Havmoeller R., Narayanan K., Singh D., Rienstra M., Benjamin E.J. et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014; 129 (8): 837–47. DOI: 10.1161/circulationaha.113.005119
  2. Colilla S., Crow A., PetkunW., Singer D.E., Simon T., Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am. J. Cardiol. 2013; 112 (8): 1142–7. DOI: 10.1016/j.amjcard.2013.05.063
  3. Zoni-Berisso M., Lercari F., Carazza T., Domenicucci S. Epidemiology of atrial fibrillation: European perspective. Clin. Epidemiol. 2014; 6: 213–20. DOI: 10.2147/clep.s47385
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  9. Lustgarten D.L., Keane D., Ruskin J. Cryothermal ablation: mechanism of tissue injury and current experience in the treatment of tachyarrhythmias. Prog. Cardiovasc. Dis. 1999; 41 (6): 481–98. DOI: 10.1016/s0033-0620(99)70024-1
  10. Khairy P., Chauvet P., Lehmann J., Lambert J., Macle L., Tanguay J.F. et al. Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation. 2003; 107 (15): 2045–50. DOI: 10.1161/01.cir.0000058706.82623.a1
  11. Dubuc M., Roy D., Thibault B., Ducharme A., Tardif J.C., Villemaire C. et al. Transvenous catheter ice mapping and cryoablation of the atrioventricular node in dogs. Pacing Clin. Electrophysiol. 1999; 22 (10): 1488–98. DOI: 10.1111/j.1540-8159.1999.tb00353.x
  12. Goff R.P., Quallich S.G., Buechler R.A., Bischof J.C., Iaizzo P.A. Determination of cryothermal injury thresholds in tissues impacted by cardiac cryoablation. Cryobiology. 2017; 75: 125–33. DOI: 10.1016/j.cryobiol.2017.01.002
  13. Chun K.R., Schmidt B., Metzner A., Tilz R., Zerm T., Koster I. et al. The 'single big cryoballoon' technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study. Eur. Heart J. 2009; 30 (6): 699–709. DOI: 10.1093/eurheartj/ehn570
  14. Aryana A., Mugnai G., Singh S.M., Pujara D.K., de Asmundis C., Singh S.K. et al. Procedural and biophysical indicators of durable pulmonary vein isolation during cryoballoon ablation of atrial fibrillation. Heart Rhythm. 2016; 13 (2): 424–32. DOI: 10.1016/j.hrthm.2015.10.033
  15. Kuhne M., Knecht S., Altmann D., Ammann P., Schaer B., Osswald S. et al. Validation of a novel spiral mapping catheter for real-time recordings from the pulmonary veins during cryoballoon ablation of atrial fibrillation. Heart Rhythm. 2013; 10 (2): 241–6. DOI: 10.1016/j.hrthm.2012.10.009
  16. Metzner A., Reissmann B., Rausch P., Mathew S., Wohlmuth P., Tilz R. et al. One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon. Circ. Arrhythm. Electrophysiol. 2014; 7 (2): 288–92. DOI: 10.1161/circep.114.001473
  17. Aryana A., Kowalski M., O'Neill P.G., Koo C.H., Lim H.W., Khan A. et al. Catheter ablation using the third-generation cryoballoon provides an enhanced ability to assess time to pulmonary vein isolation facilitating the ablation strategy: Shortand long-term results of a multicenter study. Heart Rhythm. 2016; 13 (12): 2306–13. DOI: 10.1016/j.hrthm.2016.08.011
  18. Andrade J.G., Dubuc M., Guerra P.G., Landry E., Coulombe N., Leduc H. et al. Pulmonary vein isolation using a second-generation cryoballoon catheter: a randomized comparison of ablation duration and method of deflation. J. Cardiovasc. Electrophysiol. 2013; 24 (6): 692–8. DOI: 10.1111/jce.12114
  19. Chierchia G.B., Di Giovanni G., Sieira-Moret J., de A.C., Conte G., Rodriguez-Manero M. et al. Initial experience of threeminute freeze cycles using the second-generation cryoballoon ablation: acute and short-term procedural outcomes. J. Interv. Card. Electrophysiol. 2014; 39 (2): 145–51. DOI: 10.1007/s10840-013-9855-x
  20. Chun K.R., Furnkranz A., Koster I., Metzner A., Tonnis T., Wohlmuth P. et al. Two versus one repeat freeze-thaw cycle(s) after cryoballoon pulmonary vein isolation: the alster extra pilot study. J. Cardiovasc. Electrophysiol. 2012; 23 (8): 814–9. DOI: 10.1111/j.1540-8167.2012.02315.x
  21. Ciconte G., Sieira-Moret J., Hacioglu E., Mugnai G., Di Giovanni G., Velagic V. et al. Single 3-minute versus double 4-minute freeze strategy for second-generation cryoballoon ablation: A single-center experience. J. Cardiovasc. Electrophysiol. 2016; 27 (7): 796–803. DOI: 10.1111/jce.12986
  22. Furnkranz A., Koster I., Chun K.R., Metzner A., Mathew S., Konstantinidou M. et al. Cryoballoon temperature predicts acute pulmonary vein isolation. Heart Rhythm. 2011; 8 (6): 821–5. DOI: 10.1016/j.hrthm.2011.01.044
  23. Boveda S., Providencia R., Defaye P., Pavin D., Cebron J.P., Anselme F. et al. Outcomes after cryoballoon or radiofrequency ablation for persistent atrial fibrillation: A multicentric propensity-score matched study. J. Interv. Card. Electrophysiol. 2016; 47 (2): 133–42. DOI: 10.1007/s10840-016-0138-1
  24. Knecht S., Kuhne M., Altmann D., Ammann P., Schaer B., Osswald S. et al. Anatomical predictors for acute and mid-term success of cryoballoon ablation of atrial fibrillation using the 28 mm balloon. J. Cardiovasc. Electrophysiol. 2013; 24 (2): 132–8. DOI: 10.1111/jce.12003
  25. Tokuda M., Matsuo S., Isogai R., Uno G., Tokutake K., Yokoyama K. et al. Adenosine testing during cryoballoon ablation and radiofrequency ablation of atrial fibrillation: A propensity score-matched analysis. Heart Rhythm. 2016; 13 (11): 2128–34. DOI: 10.1016/j.hrthm.2016.08.018
  26. Ghosh J., Martin A., Keech A.C., Chan K.H., Gomes S., Singarayar S. et al. Balloon warming time is the strongest predictor of late pulmonary vein electrical reconnection following cryoballoon ablation for atrial fibrillation. Heart Rhythm. 2013; 10 (9): 1311–7. DOI: 10.1016/j.hrthm.2013.06.014
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Об авторах

  • Ступаков Сергей Игоревич, доктор мед. наук, ст. науч. cотр., ORCID
  • Тарашвили Эка Георгиевна, канд. мед. наук, науч. cотр., ORCID
  • Яхьяев Яхья Бийболатович, врач – сердечно-сосудистый хирург, ORCID