What tissue does circumferential PV Isolation actually modulate?
What tissue does circumferential PV Isolation actually modulate?
复制标题
圆周 PV 隔离实际上调节哪些组织？
DOI：
10.1111/jce.12310
复制
发表时间：
2014
影响因子：
2.7
通讯作者：
Narayan,SanjivM
中科院分区：
文献类型：
--
作者：
McGarry,ThomasJ;Narayan,SanjivM
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice and a major cause of disabling cardiovascular symptoms, stroke, and even death 1. Recent trials employing drugs to maintain sinus rhythm 2 or to limit ventricular rate 3 have been disappointing, and have thus reinvigorated attempts to improve ablation for AF. Despite remarkable success in some patients, the overall results for AF ablation are suboptimal both for paroxysmal AF 4–6 and persistent AF, particularly after a single procedure7. Further work is clearly needed before we can declare victory over this obstinate arrhythmia.Ablation of AF is still substantially hampered by our incomplete mechanistic understanding of the arrhythmia. A reasonable mechanistic formulation is that AF, like other arrhythmias, requires 1) a trigger that induces AF and 2) a substrate that supports the maintenance of sustained AF. The mechanisms that actually induce triggers are less well studied, but may include abnormalities of the cardiac autonomic nervous system (CANS) 8, atrial stretch 9, genetic 10 or other factors. Our understanding of AF triggers advanced enormously in 1998, when Haïssaguerre et al. reported on 45 patients with paroxysmal AF whose episodes occurred frequently enough for repetitive AF onset to be observed in the laboratory 11. In this population, episodes of AF were often triggered by bursts of premature atrial depolarizations from the pulmonary veins (PV), where radiofrequency ablation eliminated AF short-term in in 62% of patients. This work laid the foundation for the strategy of eliminating triggers using pulmonary vein isolation (PVI), which has gained wide acceptance as therapy for AF 4, 1213.
