vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-2023-2-04LRHFXRvestar-1225Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESВлияние дополнительных воздействий в левом предсердии на эффективность криобаллонной аблации у пациентов с пароксизмальной формой фибрилляции предсердийAdditional left atrial lesions improve the effect of cryoballoon pulmonary vein isolation in paroxysmal atrial fibrillation patientshttps://orcid.org/0000-0002-7378-2686РачковаЮ. И.RachkovaIu. I.

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yulia.dar@yandex.ruhttps://orcid.org/0000-0001-6833-8938СергееваО. А.SergeevaO. A.

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https://orcid.org/0000-0003-1300-4986ГоревМ. В.GorevM. V.

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https://orcid.org/0000-0001-9921-1323НардаяШ. Г.NardaiaSh. G.

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https://orcid.org/0000-0003-3965-7854ГайдуковаН. А.GaidukovaN. A.

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https://orcid.org/0000-0002-5767-6533ПетелькоС. В.PetelkoS. V.

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https://orcid.org/0000-0003-4180-0445МакарычеваО. В.MakarychevaO. V.

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https://orcid.org/0000-0003-2061-2605ДолгининаС. И.DolgininaS. I.

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https://orcid.org/0000-0002-4094-7771РзаевФ. Г.RzaevF. G.

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https://orcid.org/0000-0002-6310-7636ВасильеваЕ. Ю.VasilievaE. Yu.

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https://orcid.org/0000-0001-6190-6808ШпекторА. В.ShpektorA. V.

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ГБУЗ города Москвы «Городская клиническая больница имени И.В.Давыдовского Департамента здравоохранения города Москвы»; ФГБОУВО «Московский государственный медико- стоматологический университет имени А.И.Евдокимова» МЗ РФРоссияClinical City Hospital named after I.V. Davydovsky; Moscow State University of Medicine and Dentistry named after A.I. EvdokimovRussian FederationГБУЗ города Москвы «Городская клиническая больница имени И.В.Давыдовского Департамента здравоохранения города Москвы»РоссияClinical City Hospital named after I.V. DavydovskyRussian FederationФГБОУВО «Московский государственный медико- стоматологический университет имени А.И.Евдокимова» МЗ РФРоссияMoscow State University of Medicine and Dentistry named after A.I. EvdokimovRussian Federation2023230620233022734Copyright © Рачкова Ю.И., Сергеева О.А., Горев М.В., Нардая Ш.Г., Гайдукова Н.А., Петелько С.В., Макарычева О.В., Долгинина С.И., Рзаев Ф.Г., Васильева Е.Ю., Шпектор А.В., 20232023Рачкова Ю.И., Сергеева О.А., Горев М.В., Нардая Ш.Г., Гайдукова Н.А., Петелько С.В., Макарычева О.В., Долгинина С.И., Рзаев Ф.Г., Васильева Е.Ю., Шпектор А.В.Rachkova I.I., Sergeeva O.A., Gorev M.V., Nardaia S.G., Gaidukova N.A., Petelko S.V., Makarycheva O.V., Dolginina S.I., Rzaev F.G., Vasilieva E.Y., Shpektor A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1225Цель

Цель. Оценить влияние дополнительных воздействий (ДопВ) в левом предсердии (ЛП) после завершения изоляции легочных вен (ИЛВ) на эффективность криобаллонной аблации (КБА) у пациентов с пароксизмальной формой фибрилляции предсердий (ФП).

Материал и методы исследования. Нами проведен анализ первичных процедур КБА, выполненных пациентам с пароксизмальной формой ФП за период с 2017 по 2021гг. Исследуемая группа (группа Алгоритм, n=82) набрана проспективно в 2019-2021гг. Первым этапом выполнялась КБА ИЛВ с достижением критериев изоляции. Пациентам с синусовым ритмом после окончания ИЛВ проводилась индукция ФП при помощи учащающей стимуляции предсердий. Пациентам, у которых удалось индуцировать ФП, и пациентам с ФП после окончания ИЛВ выполнялся следующий этап - нанесение ДопВ в области левых ганглионарных сплетений. При достижении стойкого синусового ритма процедура завершалась. В случае продолжения ФП или ее индукции повторной учащающей стимуляцией наносились ДопВ по задней стенке ЛП; если ФП продолжалась после завершения ДопВ или индуцировалась при учащающей стимуляции, синусовый ритм восстанавливали кардиоверсией. В группу контроля (группа Контроль, n=94) ретроспективно включены пациенты, которым в 2017-2019 гг рутинно выполнялась только КБА ИЛВ с достижением критериев изоляции. В случае продолжения ФП, синусовый ритм восстанавливали кардиоверсией. Попытки индукции ФП во время процедуры не проводились.

Результаты

Результаты. Группы Алгоритм и Контроль были сопоставимы по клинико-демографическим и электрофизиологическим характеристикам. Через 12 месяцев эффективность процедуры в группе Алгоритм была выше, чем в группе Контроль (78% против 62,8%, р=0,044). Значимых осложнений не было.

Заключение

Заключение. Таким образом, поэтапное выполнение ДопВ в ЛП повышает эффективность КБА в отдаленном периоде и не влияет на риск развития осложнений.

Aim

Aim. Cryoballoon ablation (CBA) is one of the methods for catheter pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF). Left atrial additional lesion (LAAL) to PVI were proposed to eliminate extrapulmonary AF triggers. Nonetheless whether the additional lesions improve CBA effectiveness is not clear.

Methods

Methods. Primary CBA procedures performed for paroxysmal AF during 2017-2021 were analyzed. The study group (Algorithm group, n=82) was recruited prospectively in 2019-2021. As the first step CBA PVI were performed in all pts. In those who were on sinus rhythm (SR) after the PVI, AF induction attempts with burst atrial pacing were performed. Pts with induced AF and those who stayed on AF after PVI underwent LAAL at the left ganglionated plexus area. In case of stable SR (non-inducible AF) the procedure finished. If AF was inducible or did not terminate during CBA, the second LAAL set were performed - LA posterior wall lesions. If AF was still inducible or did not terminate, the SR was restored by electrical cardioversion. The control group (Control group, n=94) was formed retrospectively from patients with routinely performed only CBA PVI with achievement of isolation criteria in 2017-2019. If AF continued, sinus rhythm was restored by cardioversion. There were no attempts of induction AF during the procedure.

Results

Results. The Algorithm and Control groups were comparable in terms of clinical, demographic and electrophysiological characteristics. At 12 months postoperatively, the effectiveness was higher in the Algorithm group than in the Control group (78.0% vs. 62.8%, p = 0.044). No adverse effects were found.

Conclusion

Conclusion. Thus, the stepwise approach with LAAL increases the effectiveness of CBA in the long-term period and does not affect the risk of complications.

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The authors declare that there are no conflicts of interest present.