Mapping-guided ablation of pulmonary veins to cure atrial fibrillation
Mapping-guided ablation of pulmonary veins to cure atrial fibrillation
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DOI：
10.1016/s0002-9149(00)01186-3
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发表时间：
2000-11-02
影响因子：
2.8
通讯作者：
Clémenty, J
中科院分区：
文献类型：
--
作者：
Haïssaguerre, M;Shah, DC;Clémenty, J
导管消融诱发心房颤动（AF）阵发的诱因是治疗这种常见心律失常的新兴疗法。在一系列连续 225 名对多种药物耐药的 AF 患者中，96% 的患者出现源自一根或多根肺静脉 (PV) 的触发病灶，无论患者是否患有异位性心脏病或结构性心脏病。本文描述了适用于个体患者的标测和消融技术：(1) 定义致心律失常性 PV 的标准； (2) 使用挑衅动作； (3) 圆周标测导管在提供 PV 肌肉的范围、分布和激活以及在消融过程中监测远端 PV 电位 (PVP) 方面的作用。射频消融可以通过在窦性心律（右 PV）或左心房起搏（左 PV）期间以 PVP 为目标进行，以消除 PVP 为程序终点，这比抑制急性异位更能有效地预测成功结果。目前，70% 的患者已完全消除房颤，从而可以中断心律失常并使用抗凝剂。预计持续的技术改进将改进和促进这种治疗 AF 的技术。 (C) 2000 年，Excerpta Medica, Inc.
Catheter ablation of triggers inducing paroxysms of atrial fibrillation (AF) is an emerging therapy for this common arrhythmia. In a series of 225 consecutive patients with AF resistant to multiple drugs, 96% presented with triggering foci originating from 1 or multiple pulmonary veins (PV), independently of whether or not the patient had ectopy or structural heart disease. The present article describes the mapping and ablation techniques applicable to individual patients: (1) criteria to define an arrhythmogenic PV; (2) use of provocative maneuvers; and (3) the role of circumferential mapping catheters to provide extent, distribution, and activation of PV muscle as well as monitoring distal PV potentials (PVP) during ablation. Radiofrequency oblation can be performed by targeting the PVP during sinus rhythm (right PV) or left atrial pacing (left PV) with the procedural endpoint of PVP elimination, which is more effective in predicting a successful outcome than suppression of acute ectopy. Complete elimination of AF is presently obtained in 70% of patients, allowing interruption of arrhythmias and in use anticoagulants. It is anticipated that continued technologic improvements will improve and facilitate this technique of curative treatment of AF. (C) 2000 by Excerpta Medica, Inc.