Catheter ablation in patients with persistent atrial fibrillation.
Catheter ablation in patients with persistent atrial fibrillation.
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DOI：
10.1093/eurheartj/ehw260
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发表时间：
2017-01-01
影响因子：
39.3
通讯作者：
Calkins H
中科院分区：
文献类型：
--
作者：
Kirchhof P;Calkins H
越来越多的证据表明，与抗心律失常药物治疗相比，导管消融的疗效明显优于抗心律失常药物治疗，因此，导管消融越来越多地提供给有房颤症状的患者。目前，大约三分之一的房颤消融手术是在持续性或长期持续性房颤患者身上进行的。在这里，我们回顾现有的信息来指导这些更慢性的房颤的导管消融治疗。我们确定了以下原则：我们区分阵发性和持续性房颤的临床能力是有限的。肺静脉隔离术是持续性房颤导管消融的一种合理有效的首选方法。其他消融策略正在开发中，需要在对照的多中心试验中进行适当的评估。通过生活方式干预和药物治疗促进房颤复发的伴随条件的治疗应该是持续性房颤导管消融的常规辅助手段。早期节律控制疗法有生物学基础，评估其价值的试验正在进行中。显然需要产生更多的证据，以充分动力的多中心对照试验的形式，为肺静脉隔离以外的持续性房颤消融的最佳方法提供更多的证据。
Catheter ablation is increasingly offered to patients who suffer from symptoms due to atrial fibrillation (AF), based on a growing body of evidence illustrating its efficacy compared with antiarrhythmic drug therapy. Approximately one-third of AF ablation procedures are currently performed in patients with persistent or long-standing persistent AF. Here, we review the available information to guide catheter ablation in these more chronic forms of AF. We identify the following principles: Our clinical ability to discriminate paroxysmal and persistent AF is limited. Pulmonary vein isolation is a reasonable and effective first approach for catheter ablation of persistent AF. Other ablation strategies are being developed and need to be properly evaluated in controlled, multicentre trials. Treatment of concomitant conditions promoting recurrent AF by life style interventions and medical therapy should be a routine adjunct to catheter ablation of persistent AF. Early rhythm control therapy has a biological rationale and trials evaluating its value are underway. There is a clear need to generate more evidence for the best approach to ablation of persistent AF beyond pulmonary vein isolation in the form of adequately powered controlled multi-centre trials.