学術雑誌論文 HotBalloon Ablation of the Pulmonary Veins for Paroxysmal AF

Sohara, Hiroshi  ,  Ohe, Tohru  ,  Okumura, Ken  ,  Naito, Shigeto  ,  Hirao, Kenzo  ,  Shoda, Morio  ,  Kobayashi, Youichi  ,  Yamauchi, Yasuteru  ,  Yamaguchi, Yoshio  ,  Kuwahara, Taishi  ,  Hirayama, Haruo  ,  YeongHwa, Chun  ,  Kusano, Kengo  ,  Kaitani, Kazuaki  ,  Banba, Kimikazu  ,  Fujii, Satoki  ,  Kumagai, Koichiro  ,  Yoshida, Hisashi  ,  Matsushita, Masashi  ,  Satake, Shutaro  ,  Aonuma, Kazutaka

68 ( 25 )  , pp.2747 - 2757 , 2016-12 , Elsevier
ISSN:0735-1097
NII書誌ID(NCID):AA10632119
内容記述
BackgroundPoint-by-point catheter ablation is an established treatment for drug-refractory paroxysmal atrial fibrillation (PAF). However, it is time consuming, requires excellent technique to achieve complete pulmonary vein (PV) isolation, and is associated with severe complications.
ObjectivesThe purpose of this study was to evaluate the safety and effectiveness of a HotBalloon ablation (HBA) compared with antiarrhythmic drug therapy (ADT) for the treatment of PAF.
MethodsA prospective multicenter randomized controlled study was conducted in Japan. Patients with symptomatic PAF refractory to antiarrhythmic drugs (Class I to IV) were randomized to HBA or ADT at a 2:1 ratio and assessed for effectiveness in a comparable 9-month follow-up period.
ResultsA total of 100 patients in the HBA group and 43 patients in the ADT group received treatment at 17 sites. HBA procedure produced acute complete PV isolation in 98.0% (392 of 400) of the PVs and in 93.0% (93 of 100) of patients in the HBA group. The chronic success rates after the 9-month effective evaluation period were 59.0% in the HBA group (n = 100) and 4.7% in the ADT group (n = 43; p < 0.001). The incidence of major complications was 11.2% (15 of 134 patients). The incidences of PV stenosis (>70%) and transient phrenic nerve injury were 5.2% and 3.7%, respectively. The mean fluoroscopy time was 49.4 ± 26.6 min (n = 134), and the mean procedure duration was 113.9 ± 31.9 min (n = 133).
ConclusionsThis study demonstrates the superiority of HBA compared with ADT for treatment of patients with PAF, and a favorable safety profile.
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