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房颤的射频消融治疗
作者:庄燕1  陈明龙2 
单位:1. 江苏省中医院 重症医学科, 江苏 南京 210029;
2. 南京医科大学第一附属医院 心脏科, 江苏 南京 210029
关键词:心房颤动 导管消融 机制 文献综述 
分类号:R54
出版年·卷·期(页码):2014·33·第四期(531-536)
摘要:

心房颤动是最常见的心律失常,可引起中风、心功能不全,导致心血管疾病死亡率增高。药物治疗房颤无论在治疗效果还是在不良反应发生率方面均存在较多问题,因此,射频消融术应运而生,并且在过去的几十年间得到了飞速发展,其治疗房颤的成功率也逐渐提高。但射频消融治疗房颤也存在因追求高成功率而扩大消融范围的问题,另外整个射频消融过程对于技术的要求还是相当高的。由于房颤的发生机制极其复杂,目前尚有许多未解之谜,这就使得根据房颤发生机制来有针对性地消融病灶还不太可能。近十年来,对于房颤发生机制的研究如火如荼,而这一定程度上为安全、有效的房颤消融提供了可能。作者就房颤的发生机制、射频消融术患者的选择、消融技术及策略的变化以及持续性房颤的消融等作一综述,以期为临床工作提供一些帮助。

参考文献:

[1] MIYASAKA Y,BARNES M E,GERSH B J et al.Secular trends in incidence of atrial fibrillation in Olmsted County,Minnesota,1980 to 2000,and implications on the projections for future prevalence[J].Circulation,2006,114(2):119-125.
[2] NACCARELLI G V,VARKER H,LIN J,et al.Increasing prevalence of atrial fibrillation and flutter in the United States[J].Am J Cardiol,2009,104:1534-1539.
[3] YOSHIDA K,CHUGH A,GOOD E,et al.A critical decrease in dominant frequency and clinical outcome after catheter ablation of persistent atrial fibrillation[J].Heart Rhythm,2010,7:295-302.
[4] Le HEUZEY J Y,PAZIAUD O,PIOT O,et al.Cost of care distribution in atrial fibrillation patients:the COCAF study[J].Am Heart J,2004,147:121-126.
[5] YAMAZAKI M,JALIFE J.Pathophysiology of atrial fibrillation:from initiation to maintenance[J].Journal of Arrhythmia,2012,28:129-139.
[6] LEWIS T.The mechanism and graphic registration of the heart beat[M].3rd ed.London:Shaw,1925.
[7] MOE G.On the multiple wavelet hypothesis of atrial fibrillation[J].Arch Int Pharmacodyn Ther,1962,140:183-188.
[8] MOE G K,ABILDSKOV J A.Atrial fibrillation as a self-sustaining arrhythmia independent of focal discharge[J].Am Heart J,1959,58:59-70.
[9] ALLESSIE M,LAMMERS W,BONKE F,et al.Experimental evaluation of Moe's multiple wavelet hypothesis of atrial fibrillation[M]//Zaipes D,Jalife J.Cardiac Electrophysiology and Arrhythmia.Orlando,FL:Grune and Stratton,1985,265-275.
[10] HAÏSSAGUERRE M,SHAH D C,JAÏS P,et al.Electrophysiological breakthroughs from the left atrium to the pulmonary veins[J].Circulation,2000,14,102(20):2463-2465.
[11] ZHAO Q Y,HUANG H,TANG Y H,et al.Relationship between autonomic innervation in crista terminalis and atrial arrhythmia[J].J Cardiovasc Electrophysiol,2009,20:551-557.
[12] WORKMAN A J.Cardiac adrenergic control and atrial fibrillation[J].Naunyn Schmiedebergs Arch Pharmacol,2010,381(3):235-249.
[13] MAO J,SCHERLAG B J,LIU Y,et al.The atrial neural network as a substrate for atrial fibrillation[J].J Interv Card Electrophysiol,2012,35(1):3-9.
[14] HUANG C X,ZHAN Q Y,JIANG H,et al.Experimental study of the effect of the vagus nerve on atrial electrical remodeling[J].J Electrocardiol,2003,36:295-300.
[15] WYSE D G,WALDO A L,DIMARCO J P,et al.A comparison of rate control and rhythm control in patients with atrial fibrillation[J].N Engl J Med,2002,347:1825-1833.
[16] BENJAMIN E J,DAGOSTINO R B,BELANGER A J,et al.Left atrial size and the risk of stroke and death.The Framingham Heart Study[J].Circulation,1995,92:835-841.
[17] LEUNGDY,BOYD A,NGA A,et al.Echocardiographic evaluation of left atrial size and function:current understanding,pathophysiologic correlates,and prognostic implications[J].Am Heart J,2008,156:1056-1064.
[18] KUPPAHALLY S S,AKOUM N,BADGER T J,et al.Echocardiographic left atrial reverse remodeling after catheter ablation of atrial fibrillation is predicted by preablation delayed enhancement of left atrium by magnetic resonance imaging[J].Am Heart J,2010,160:877-884.
[19] TOPS L F,BAX J J,ZEPPENFELD K,et al.Effect of radiofrequency catheter ablation for atrial fibrillation on left atrial cavity size[J].Am J Cardiol,2006,97:1220-1222.
[20] TOPS L F,DELGADO V,BERTINI M,et al.Left atrial strain predict sreverse remodeling after catheter ablation for atrial fibrillation[J].J Am Coll Cardiol,2011,57:324-331.
[21] SANDERS P,MORTON J B,MORGAN J G,et al.Reversal of atrial mechanical stunning after cardioversion of atrial arrhythmias:implications for the mechanisms of tachycardia-mediated atrial cardiomyopathy[J].Circulation,2002,106:1806-1813.
[22] BUBER J,LURIA D,STERNIK L,et al.Left atrial contractile function following a successful modified Maze procedure at surgery and the risk for subsequent thromboembolic stroke[J].J Am Coll Cardiol,2011,58:1614-1621.
[23] CASACLANG-VERZOSA G,GERSH B J,Tsang T S.Structural and functional remodeling on the left atrium:clinical and therapeutic implications for atrial fibrillation[J].J Am Coll Cardiol,2008,51:1-11.
[24] LEMOLA K,ORAL H,CHUGH A,et al.Pulmonary vein isolation as an endpoint for left atrial circumferential ablation of atrial fibrillation[J].J Am Coll Cardiol,2005,46:1060-106.
[25] LEMOLA K,CHARTIER D,YEH Y H,et al.Pulmonary vein region ablation in experimental vagal atrial fibrillation:role of pulmonary veins versus autonomic ganglia[J].Circulation,2008,117:470-477.
[26] CHUGH A,ORAL H,LEMOLA K,et al.Prevalence,mechanisms,and clinical significance of macro-reentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation[J].Heart Rhythm,2005,2:464-471.
[27] CALKINS H,BRUGADA J,PACKER D L,et al.HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation:recommendations for personnel,policy,procedures and follow-up.A report of the Heart Rhythm Society(HRS) Task Force on catheter and surgical ablation of atrial fibrillation[J].Heart Rhythm,2007,4:816-861.
[28] CHAE S,ORAL H,GOOD E,et al.Atrial tachycardia after circumferential pulmonary vein ablation of atrial fibrillation:mechanistic insights,results of catheter ablation,and risk factors for recurrence[J].J Am Coll Cardiol,2007,50:1781-1787.
[29] CUMMINGS J E,SCHWEIKERT R,SALIBA W,et al.Left atrial flutter following pulmonary vein atrium isolation with radiofrequency energy:linear lesions or repeat isolation[J].J Cardiovasc Electrophysiol,2005,16:293-297.
[30] OUYANG F,ANTZ M,ERNST S,et al.Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins:lessons from double Lasso technique[J].Circulation,2005,111:127-135.
[31] ORAL H,CHUGH A,GOOD E,et al.A tailored approach to catheter ablation of paroxysmal atrial fibrillation[J].Circulation,2006,113:1824-1831.
[32] POKUSHALOV E,ROMANOV A,SHUGAYEV P,et al.Selective ganglionatedplexi ablation for paroxysmal atrial fibrillation[J].Heart Rhythm,2009,6:1257-1264.
[33] PRATOLA C,BALDO E,NOTARSTEFANO P,et al.Radiofrequency ablation of atrial fibrillation:is the persistence of all intraprocedural targets necessary for long-term maintenance of sinus rhythm?[J]Circulation,2008,117:136-143.
[34] OUYANG F,TILZ R,CHUN J,et al.Long-term results of catheter ablation in paroxysmal atrial fibrillation:lessons from a 5-yearfollow-up[J].Circulation,2010,122:2368-2377.
[35] MACLE L,JAIS P,WEERASOORIYA R,et al.Irrigated-tip catheter ablation of pulmonary veins for treatmen to atrial fibrillation[J].J Cardiovasc Electrophysiol,2002,13:1067-1073.
[36] HAISSAGUERRE M,HOCLHI M,SANDERS P,et al.Catheter ablation of long-lasting persistent atrial fibrillation:clinical outcome and mechanisms of subsequent arrhythmias[J].J Cardiovasc Electrophysiol,2005,16:1138-1147.
[37] HAISSAGUERRE M,SANDERS P,HOCIHI M,et al.Catheter ablation of long-lasting persistent atrial fibrillation:critical structures for termination[J].J Cardiovasc Electrophysiol,2005,16:1125-1137.
[38] KUCK K H,REDDY V Y,SCHMIDT B,et al.A novel radiofrequency ablation catheter using contact force sensing:Toccata study[J].Heart Rhythm,2012,9:18-23.
[39] KERST G,WEIG H J,WERETKA S,et al.Contact force-controlled zero-fluoroscopy catheter ablation of right-sided and left atrial arrhythmia substrates[J].Heart Rhythm,2012,9:709-714.
[40] SAWHNEY N,ANOUSHEH R,CHEN W,et al.Circumferential pulmonary vein ablation with additional linear ablation results in an increased incidence of left atrial flutter compared with segmental pulmonary vein isolation as an initial approach to ablation of paroxysmal atrial fibrillation[J].Circ Arrhythmia Electrophysiol,2010,3:243-248.
[41] NADEMANEE K,MCKENZIE J,KOSAR E,et al.A new approach for catheter ablation of atrial fibrillation:mapping of the electrophysiologic substrate[J].J Am Coll Cardiol,2004,43:2044-2053.
[42] ELAYI C S,VERMA A,DIBUASE L,et al.A blation for longstanding permanent atrial fibrillation:results from a randomized study comparing three different strategies[J].Heart Rhythm,2008,5:1658-1664.
[43] SCHERR D,DALAL D,CHEEMA A,et al.Automated detection and characterization of complex fractionated atrial electrograms in human left atrium during atrial fibrillation[J].Heart Rhythm,2007,4:1013-1020.
[44] WU J,ESTNER H,LUIK A,et al.Automatic 3D mapping of complex fractionated atrial electrograms(CFAE) in patients with paroxysmal and persistent atrial fibrillation[J].J Cardiovasc Electrophysiol,2008,19:897-903.
[45] TADA H,YOSHIDA K,CHUGH A,et al.Prevalence and characteristics of continuous electrical activity in patients with paroxysmal and persistent atrial fibrillation[J].J Cardiovasc Electrophysiol,2008,19:606-612.
[46] YOSHIDA K,CHUGH A,UIFARSSON M,et al.Relationship between the spectral characteristics of atrial fibrillation and atrial tachycardias that occur after catheter ablation of atrial fibrillation[J].Heart Rhythm,2009,6:11-17.
[47] KNECHT S,HOCINI M,WRIGHT M,et al.Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation[J].Eur Heart J,2008,29:2359-2366.
[48] KUROTOBI T,SHIMADA Y,KINO N,et al.Local coronary flow is associated with an unsuccessful complete block line at the mitral isthmus in patients with atrial fibrillation[J].Circ Arrhythmia Electrophysiol,2011,4:838-843.
[49] YOKOKAWA M,SUNDARAM B,GARG A,et al.Impact of mitral isthmus anatomy on the likelihood of achieving linear block in patients undergoing catheter ablation of persistent atrial fibrillation[J].Heart Rhythm,2011,8:1404-1410.
[50] HAISSAGUERRE M,SANDERS P,HOCINI M,et al.Changes in atrial fibrillation cycle length and inducibility during catheter ablation and their relation to outcome[J].Circulation,2004,109:3007-3013.
[51] ORAL H,CHUGH A,GOOD E,et al.Radiofrequency catheter ablation ochronic atrial fibrillation guided by complex electrograms[J].Circulation,2007,115:2606-2612.
[52] ELAYI C S,DIBIASE L,BARRETT C,et al.Atrial fibrillation termination as a procedural endpoint during ablation in long-standing persistent atrial fibrillation[J].Heart Rhythm,2010,7:1216-1223.
[53] YOSHIDA K,RABBANI A B,ORAL H,et al.Left atrial volume and dominant frequency of atrial fibrillation in patients undergoing catheter ablation of persistent atrial fibrillation[J].J Interventional Card Electrophysiol,2011,32:155-161.

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