肺静脉结构特点及左心房内径与心房颤动经导管射频消融术后复发的关系

目的 探讨肺静脉结构特点及左心房内径(LAD)与心房颤动(房颤)经导管射频消融术后复发的相关性.方法 收集267例经导管射频消融房颤患者的术前资料,通过经食管超声心动图测量LAD,螺旋CT测量左上肺静脉(LSPV)、左下肺静脉(LIPV)、右上肺静脉(RSPV)和右下肺静脉(RIPV)的CT值及肺静脉变异情况.所有患者都成功进行经导管射频消融治疗,并在术后随访10个月.通过单因素和多因素Cox回归分析肺静脉结构特点,LAD及其他因素与术后复发的相关性.结果 267例入选患者中,复发44例.复发组与无复发组相比,LAD、LSPV、RSPV、左侧总肺静脉和上侧总肺静脉平均直径明显增大(P＜0.05).经单因素及多因素Cox回归分析显示LAD、上侧总肺静脉直径、房颤类型以及房颤病程是房颤射频消融术后复发的独立危险因素.结论 LAD越大、上肺静脉开口越宽的房颤患者,经导管射频消融术后越容易复发,而病程较长和持续性房颤亦是房颤射频消融术后复发的独立预测因素.     

左心房低电压区预测心房颤动患者导管消融术后复发的Meta分析

目的:探讨左心房低电压区与心房颤动(房颤)导管消融术后复发的相关性.方法:系统检索建库至2020年9月3日PubMed、Embase、Cochrane Library、Web of Science、维普、中国知网、万方数据库及中国生物医学文献数据库关于左心房低电压区与房颤导管消融术后复发相关性的研究.应用RevMan5...     

心房颤动家族史与年轻心房颤动患者导管消融术后复发的关系

目的:探讨心房颤动家族史与年轻(≤50岁)心房颤动患者导管消融术后复发的关系.方法:中国心房颤动注册研究从2011年8月至2018年12月前瞻性纳入25512例心房颤动患者.在排除瓣膜性心房颤动、既往行导管消融、术后随访<3个月的患者后,2919例接受导管消融治疗且首次心电图诊断心房颤动时年龄≤50岁的患者纳入本研究....     

持续性心房颤动经导管射频消融术后复发的临床分析

目的探讨持续性心房颤动患者经导管射频消融术后复发的相关因素.方法纳入2011年4月至2017年10月期间于中国医科大学附属第一医院行房颤导管消融的持续性房颤患者100例.术前收集患者一般临床资料、检验结果及超声心动图指标,术后对所有患者进行随访,根据术后3个月后是否复发,将患者分为复发组与未复发组,对两组各项临床资料进行统计学分析,以明确影响术后复发的临床因素.结果 100例房颤术后患者47例复发,多因素Logistic回归分析显示,血小板计数水平(OR=1.617,95%CI1.005~2.029,P=0.017)、左心耳自发显影(OR=3.980,95%CI 1.279~12.390,P=0.007)、左心房直径(OR=5.556,95%CI 1.791~17.289,P=0.004)是持续性房颤患者消融术后房颤复发的独立危险因素(P<0.05).结论血小板计数水平、左心耳自发显影、左心房直径为预测持续性房颤患者消融术后复发的重要指标.     

心房颤动导管消融术后抗心律失常药物与复发的关系

目的探讨抗心律失常药物对心房颤动(简称房颤)导管消融术后早期复发和晚期复发的影响。方法210例房颤患者在三维电解剖标测系统和肺静脉环状标测电极联合指导下行环肺静脉电隔离。术后应用抗心律失常药物3个月,其中服用普罗帕酮29例、胺碘酮113例、索他洛尔3例,未服用药物65例,因索他洛尔组病例数少仅对前三组进行分析。早期复发定义为导管消融3个月内发生快速性房性心律失常,晚期复发定义为导管消融3个月后停用抗心律失常药物后发生快速性房性心律失常。结果三组平均年龄具有显著差异,余基线资料无显著性差异。术后3个月内共88例(41.9%)出现早期复发,普罗帕酮、胺碘酮、未服用抗心律失常药物三组早期复发率分别为41.4%,32.7%,55.4%,具有显著差异(P=0.013)。Logistic分析显示胺碘酮与早期复发独立相关(比数比=0.37,95%可信区间0.19～0.72,P=0.003)。随访180±75(91～374)天,66例(31.4%)晚期复发,三组晚期复发率分别为34.5%,28.3%,32.3%,无显著差异(P=0.752)。Logistic分析显示抗心律失常药物不是晚期复发的独立危险因素(P=0.978)。服索他洛尔3例均出现早期复发和晚期复发。结论术后服用抗心律失常药物特别是胺碘酮可显著降低房颤导管消融的早期复发,但对晚期复发无影响。     

红细胞分布宽度与阵发性心房颤动导管射频消融术后复发的关系

目的 探讨红细胞分布宽度（RDW）与阵发性心房颤动(简称房颤)导管射频消融术后复发的关系及其相关机制。 方法 连续收集2013年1月~2014年12月在本中心行射频消融治疗的阵发性房颤患者,收集其基线资料并随访其术后复发情况。按照复发与否分为复发组与未复发组,统计分析两组间基线资料、实验室检验指标和超声心动图测定值间的差异, Logistic回归分析差异指标对消融术后复发率的预测价值。结果 共105人纳入研究,随访（8±4）个月,共计复发36例。统计数据表明:两组间基线资料无明显差异,实验室检测指标和超声心动图测定值中仅RDW在复发组显著高于未复发组（P<0.05）。二分类Logistic回归分析显示:RDW是阵发性房颤射频消融术后复发的独立预测因素（OR=2.847,P<0.05）。将RDW采用中值分组后比较示:Q2组较Q1组复发率明显增高（P<0.05）,具有统计学意义。进一步分析显示:当RDW(%)取最佳截断值13.25%时,对阵发性心房颤动术后复发的预测灵敏度达64%,特异度为67%。结论 RDW是阵发性房颤患者射频消融术后复发的一项独立预测因素。     

无左心房和肺静脉三维重建的阵发性心房颤动导管消融术

目的探讨无左心房和肺静脉三维重建与有左心房三维重建的Carto系统引导下阵发性心房颤动（房颤）导管消融术的差异。方法入选2008年1月至12月在本中心由同一位熟练术者行Carto系统引导下导管消融术的阵发性房颤患者31例,其中17例接受无左心房和肺静脉三维重建的消融术（非重建组）,14例接受有左心房三维重建的消融术（重建组）。具体消融方法为以环肺静脉电隔离为基础,按照个体情况选择是否行三尖瓣峡部画线消融。消融终点均为肺静脉电位与心房完全隔离,电生理检查不可诱发持续的房颤、心房扑动和房性心动过速。对比上述两组患者消融术中各步骤的耗时情况,并进行随访。结果重建组男女比例为10：4,非重建组为11：6,P〉0．05;重建组年龄（54．64±15．58）岁,非重建组（59．41±10．59）岁,P〉0．05;重建组房颤病程（5．05±10．4）年,非重建组为（7．34±7．74）年,P〉0．05。重建组左心房内径（35．29±4．73）mm,非重建组是（36．47±6．15）mm,P〉0．05。重建组消融术时间（107．23±28．92）min,非重建组是（93．47±26．09）min,P〉0．05;重建组X线曝光时间（21．09±6．49）min,非重建组是（14．16±5．35）min,P〈0．05;重建组环右肺静脉消融时间（27．29±18．53）min,非重建组是（18．00±4．51）min,P〈0．05;重建组环左肺静脉消融时间（28．14±9．26）min,非重建组是（23．94±7．10）min,P〈0．05。消融术后随访2～13个月,重建组85．7％无明显房颤发作,非重建组是82．4％（P〉0．05）。结论与有左心房三维重建的Carto系统引导下的阵发性房颤导管消融术相比,无左心房和肺静脉三维重建可以缩短消融术和x线曝光时间,可以达到相同的消融效果。     

无左心房和肺静脉三维重建的阵发性心房颤动导管消融术

Objective To investigate the differences between modeling and non-modeling left atrium in Carto XP system guided catheter ablation for paroxysmal atrial fibrillation. Methods Thirty-one cases of par-oxysmal atrial fibrillation treated by the same electrophysiologist with guidance of Carto XP during Jan to Dec in 2008 were enrolled. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients (non-modeling group) and with left atrium modeling in 14 patients (modeling group). The detailed ablation method was based on circumferential pulmonary veins isolation (CPVI). And linear ablation of tricus-pid valvular isthmus was selectively proceeded individually. The ablation endpoint was set to complete isolation of pulmonary vein potential from left atrium and no continuous fast atrial arrhythmia including atrial fibrillation, atrial flutter and atrial tachycardia could be induced. Comparisons for each step during procedure and the fol-low-up outcomes had been done. Results The male: female ratio of the 2 groups were 10:4 and 11 : 6 (P >0.05). The average age were (54.64 ± 15.58) and (59.41 ± 10.59) (P >0.05) ,the diseased courses were (5.05 ±10.4) years and (7.34±7.74)years(P >0.05),the left atrial sizes were (35.29±4.73) mm and (36.47 ±6.15)mm (P > 0.05), the total procedure time was (107.23±28.92) rain and (93.47 ±26.09) win (P>0.05). The X-ray exposure time was (21.09 ±6.49)min (modeling group) and (14.16±5.35)min (non-modeling group,P < 0.05). The CPVI time of fight pulmonary veins was (27.29±18.53) rain (model-ing group) and 18.00 ±4.51 min (non-modeling group, P < 0.05). The CPVI time of left pulmonary veins was (28.14 ±9.26) rain (modeling group) and (23.94±7.10) rain (non-modeling group, P < 0.05). The successful rates was 85.7% (modeling group) and 82.4% (non-modeling group, P > 0.05) over follow-up for 2 to 13 months. Conclusion Carto system guided catheter ablation of paroxysmal atrial fibrillation without modeling of left atrium and pulmonary veins could take less time in X-ray exposure and ablation steps, compa-ring with left atrium modeling one.     

无左心房和肺静脉三维重建的阵发性心房颤动导管消融术

Objective To investigate the differences between modeling and non-modeling left atrium in Carto XP system guided catheter ablation for paroxysmal atrial fibrillation. Methods Thirty-one cases of par-oxysmal atrial fibrillation treated by the same electrophysiologist with guidance of Carto XP during Jan to Dec in 2008 were enrolled. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients (non-modeling group) and with left atrium modeling in 14 patients (modeling group). The detailed ablation method was based on circumferential pulmonary veins isolation (CPVI). And linear ablation of tricus-pid valvular isthmus was selectively proceeded individually. The ablation endpoint was set to complete isolation of pulmonary vein potential from left atrium and no continuous fast atrial arrhythmia including atrial fibrillation, atrial flutter and atrial tachycardia could be induced. Comparisons for each step during procedure and the fol-low-up outcomes had been done. Results The male: female ratio of the 2 groups were 10:4 and 11 : 6 (P >0.05). The average age were (54.64 ± 15.58) and (59.41 ± 10.59) (P >0.05) ,the diseased courses were (5.05 ±10.4) years and (7.34±7.74)years(P >0.05),the left atrial sizes were (35.29±4.73) mm and (36.47 ±6.15)mm (P > 0.05), the total procedure time was (107.23±28.92) rain and (93.47 ±26.09) win (P>0.05). The X-ray exposure time was (21.09 ±6.49)min (modeling group) and (14.16±5.35)min (non-modeling group,P < 0.05). The CPVI time of fight pulmonary veins was (27.29±18.53) rain (model-ing group) and 18.00 ±4.51 min (non-modeling group, P < 0.05). The CPVI time of left pulmonary veins was (28.14 ±9.26) rain (modeling group) and (23.94±7.10) rain (non-modeling group, P < 0.05). The successful rates was 85.7% (modeling group) and 82.4% (non-modeling group, P > 0.05) over follow-up for 2 to 13 months. Conclusion Carto system guided catheter ablation of paroxysmal atrial fibrillation without modeling of left atrium and pulmonary veins could take less time in X-ray exposure and ablation steps, compa-ring with left atrium modeling one.     

无左心房和肺静脉三维重建的阵发性心房颤动导管消融术

Objective To investigate the differences between modeling and non-modeling left atrium in Carto XP system guided catheter ablation for paroxysmal atrial fibrillation. Methods Thirty-one cases of par-oxysmal atrial fibrillation treated by the same electrophysiologist with guidance of Carto XP during Jan to Dec in 2008 were enrolled. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients (non-modeling group) and with left atrium modeling in 14 patients (modeling group). The detailed ablation method was based on circumferential pulmonary veins isolation (CPVI). And linear ablation of tricus-pid valvular isthmus was selectively proceeded individually. The ablation endpoint was set to complete isolation of pulmonary vein potential from left atrium and no continuous fast atrial arrhythmia including atrial fibrillation, atrial flutter and atrial tachycardia could be induced. Comparisons for each step during procedure and the fol-low-up outcomes had been done. Results The male: female ratio of the 2 groups were 10:4 and 11 : 6 (P >0.05). The average age were (54.64 ± 15.58) and (59.41 ± 10.59) (P >0.05) ,the diseased courses were (5.05 ±10.4) years and (7.34±7.74)years(P >0.05),the left atrial sizes were (35.29±4.73) mm and (36.47 ±6.15)mm (P > 0.05), the total procedure time was (107.23±28.92) rain and (93.47 ±26.09) win (P>0.05). The X-ray exposure time was (21.09 ±6.49)min (modeling group) and (14.16±5.35)min (non-modeling group,P < 0.05). The CPVI time of fight pulmonary veins was (27.29±18.53) rain (model-ing group) and 18.00 ±4.51 min (non-modeling group, P < 0.05). The CPVI time of left pulmonary veins was (28.14 ±9.26) rain (modeling group) and (23.94±7.10) rain (non-modeling group, P < 0.05). The successful rates was 85.7% (modeling group) and 82.4% (non-modeling group, P > 0.05) over follow-up for 2 to 13 months. Conclusion Carto system guided catheter ablation of paroxysmal atrial fibrillation without modeling of left atrium and pulmonary veins could take less time in X-ray exposure and ablation steps, compa-ring with left atrium modeling one.     

心房颤动递进式线性消融后的左心房扑动

目的旨在探讨心房颤动（房颤）递进式线性消融术中出现的房性心律失常的电生理特点及消融的结果。方法对80例房颤消融中出现规律的房性心律失常进行非接触激动顺序标测,判断电生理机制并指导消融。结果共146阵心动过速,4阵为左心房房性心动过速（房速）,周长为（225±49）ms,其余142阵为左心房扑动,左心房激动时间占心动过速周长的100％,周长为（205±37）ms,均与房颤“7”字消融线上的缝隙有关。根据缝隙的位置将心房扑动的折返环分为3类：Ⅰ类（n=68）,缝隙位于左心耳-左上肺静脉间的嵴部,Ⅱ类（n=50）,缝隙位于左心房顶部,Ⅲ类（n=24）,缝隙位于二尖瓣环峡部。其中130阵消融成功,其余16阵因消融反应欠佳后经药物或体外电转复为窦性心律。随访（16．2±6．7）个月,82．5％（66／80）的患者可维持窦性心律。结论房颤递进式线性消融术中出现的房性心律失常多为大折返机制,且与“7”字消融线上的缝隙有关,这些缝隙主要位于左心耳-左上肺静脉间的嵴部。非接触标测技术能快速准确地识别这些缝隙并指导消融。     

Effect of left atrial circumferential ablation for atrial fibrillation on left atrial transport function

BACKGROUND: The effects of left atrial (LA) circumferential ablation on LA function in patients with atrial fibrillation (AF) have not been well described. OBJECTIVES: The purpose of this study was to determine the effect of LA circumferential ablation on LA function. METHODS: Gated, multiphase, dynamic contrast-enhanced computed tomographic (CT) scans of the chest with three-dimensional reconstructions of the heart were used to calculate the LA ejection fraction (EF) in 36 patients with paroxysmal (n = 27) or chronic (n = 9) AF (mean age 55 +/- 11 years) and in 10 control subjects with no history of AF. Because CT scans had to be acquired during sinus rhythm, a CT scan was available both before and after (mean 5 +/- 1 months) LA circumferential ablation (LACA) in only 10 patients. A single CT scan was acquired in 8 patients before and in 18 patients after LACA ablation. Radiofrequency catheter ablation was performed using an 8-mm-tip catheter to encircle the pulmonary veins, with additional lines along the mitral isthmus and the roof. RESULTS: In patients with paroxysmal AF, LA EF was lower after than before LACA (21% +/- 8% vs 32 +/- 13%, P = .003). LA EF after LA catheter ablation was similar among patients with paroxysmal AF and those with chronic AF (21% +/- 8% vs 23 +/- 13%, P = .7). However, LA EF after LA catheter ablation was lower in all patients with AF than in control subjects (21% +/- 10% vs 47% +/- 5%, P < .001). CONCLUSION: During medium-term follow-up, restoration of sinus rhythm by LACA results in partial return of LA function in patients with chronic AF. However, in patients with paroxysmal AF, LA catheter ablation results in decreased LA function. Whether the impairment in LA function is severe enough to predispose to LA thrombi despite elimination of AF remains to be determined.     

左心耳形态结构与房颤射频消融术后复发的关系

【摘要】 目的 探讨左心耳形态对心房颤动（房颤）导管消融术后复发的预测价值。方法 选取2019年1月至2020年1月在河南省胸科医院和郑州市第七人民医院首次行房颤射频消融的患者440例为研究对象,根据随访结果分为房颤复发组和未复发组。术前所有患者均接受左房肺静脉血管成像或食道彩超检查,根据检查结果将左心耳形态分为鸡翅形、风向标型、仙人掌型、菜花型。术后随访18个月,以消融术后复发为结局,分析左心耳形态对房颤复发的影响。结果 阵发性房颤57例（22.80%）复发,持续性房颤78例（41.05%）复发,持续性房颤患者复发率明显大于阵发性心房颤动;复发组患者左房前后径、左心房体积、左心耳体积均大于未复发组;左心耳形态学特征中,鸡翅型房颤复发率最高（37.26%）,风向标型复发率最低（21.59%）（P＜0.05）。多因素Logistic回归分析结果显示左心耳体积、持续性房颤及鸡翅型左心耳形态是房颤复发的危险因素（P＜0.05）,OR( 95% CI) 分别为1.348（1.009~1.801）、1.980（1.343~2.919）、1.687（1.021~2.786）。此外,服用ACEI/ARB类药物也有助于减少房颤复发。Kaplan-Meier生存曲线显示房颤消融术后左心耳形态累计复发率依次为鸡翅型＞仙人掌型＞菜花型＞风向标型（χ2=9.302,P=0.026）。结论 左心耳形态学特征与房颤射频消融术后复发风险相关,ACEI/ARB类药物有助于降低房颤消融术后复发。     

左房容积与心房颤动导管消融术后患者复发的关系

目的探讨左房容积(LAV)与心房颤动(简称房颤)消融术后房颤复发的相关性。方法 104例房颤患者。术前应用64排容积CT扫描,在advantage workstation4.2图像工作站中重建左房,测量LAV,术中通过三维标测系统(CARTO)指导行射频消融术,术后3个月评定治疗效果,并随访6个月。结果随访6个月结束,104例中有20例(19%)房颤复发。单因素分析结果显示,复发组平均LAV比未复发组的大[117.6±28.9cm3,95%可信区间(CI)104.1~131.1cm3vs97.1±16.8cm3,95%CI93.5~100.8cm3,P=0.006]。多因素分析显示LAV是独立的预测导管消融术后复发的指标(P(0.05,相对风险度=1.044,95%CI1.018~1.071)。结论房颤射频消融术后房颤复发与LAV大小相关。     

典型心房扑动对心房颤动导管消融复发的影响

目的 评价典型心房扑动(房扑)对心房颤动(房颤)导管消融复发的影响.方法 120例药物治疗无效的阵发性房颤患者在三维电解剖标测系统和肺静脉环状标测电极导管联合指导下行环肺静脉电隔离.其中17例(14.2%)合并典型房扑(房扑组,其余作为对照组),行三尖瓣环峡部消融,三尖瓣环峡部消融终点为三尖瓣环峡部双向阻滞.房颤复发定义为导管消融3个月后发生房性快速心律失常.结果 房扑组房颤病程(9.8±10.7)年,长于对照组(5.9±6.3)年,差异有统计学意义(P=0.036).房扑组与对照组相比,年龄、性别、合并器质性心脏病、左心房直径、左心室射血分数差异无统计学意义.随访91～401(237±79)d,房扑组房颤复发率为47.1%,对照组房颤复发率为12.6%,两组间差异有统计学意义(P=0.001).经校正年龄、房颤病程、合并器质性心脏病、左心房直径等因素,Cox多因素分析发现消融术前合并房扑是房颤复发的独立危险因素(危险比3.52,95%可信区间1.32～9.34,P=0.012).结论 典型房扑可能增加房颤导管消融术后房颤的复发,房颤导管消融前应对患者是否合并典型房扑进行认真评价.     

炎症与心房颤动导管消融的复发

目的:探讨炎症对心房颤动(房颤)导管消融复发的影响。方法:前瞻性入选第1次行环肺静脉消融的阵发性房颤患者144例,测定血清高敏C反应蛋白(CRP),根据CRP水平通过4分位法将病例分为4组,复发定义为术后3个月后发生快速性房性心律失常。结果:平均随访91～374(199±80)d,40例(27.8%)复发。复发组CRP为(3.8±5.8)mg/L,未复发组CRP为(4.2±4.7)mg/L,2组间差异无统计学意义(P>0.05)。从CRP水平最低4分位组到CRP水平最高4分位组,复发率分别为33.3%,30.6%,25.0%,22.2%,差异无统计学意义(P>0.05)。结论:炎症标记物CRP对房颤导管消融的复发无预测价值。     

肥厚型心肌病合并心房颤动导管消融术后复发的相关因素分析

目的 探讨国人肥厚型心肌病(HCM)合并心房颤动(房颤)患者导管消融术的疗效及术后心律失常复发的危险因素.方法 纳入2005年6月至2013年6月在北京安贞医院行导管消融术的HCM合并房颤患者共40例(阵发性房颤27例,持续性房颤13例).阵发性房颤的消融策略为双侧环肺静脉隔离(PVI)持续性房颤的消融策略为PVI基础上加行左心房顶部、二尖瓣峡部和三尖瓣峡部线性消融.术后以常规心电图和长程心电图随访患者心律失常复发情况,用回归分析方法甄别与心律失常复发相关的危险因素并检测其预测效力.结果 单次消融术后随访(34±18)个月,窦性心律维持率为30％ (12/40),64.3％ (18/28)的心律失常复发出现在消融术后1年.Cox多因素分析显示左心房内径(LAD)和女性是术后快速房性心律失常复发的独立危险因素(LAD:HR=1.124,95％ CI1.051～1.202,P=0.001;女性:HR=3.304,95％CI1.397 ～7.817,P=0.007).其中LAD的截断值为43.5 mm时的预测敏感度为93.5％,特异度为60.0％;LAD每增加1 mm,心律失常复发的风险比为1.095(95％CI1.031～1.163,P=0.003).结论 HCM合并房颤行导管消融术虽安全可行,但单次手术后长期随访的窦性心律维持率较低,大部分心律失常复发出现在术后1年内,左心房内径增大和女性是术后复发的独立危险因素.     

已达到消融终点的长程持续性心房颤动复发危险因素分析

目的：探讨已达到消融终点的长程持续性心房颤动（房颤）患者复发的危险因素。方法：纳入达到消融终点的长程持续性房颤患者256例,消融终点定义为双侧肺静脉电隔离,二尖瓣峡部和左心房顶部线性消融双向阻断且碎裂电位消失。根据随访结果将患者分为房颤复发组（n＝43）和无复发组（n＝213）。通过多因素 COX 回归分析探讨房颤复发的独立危险因素。结果：经过（19．5±3．6）个月随访,与无复发组相比,房颤复发组患者右心房内径较大,为（53．31±6．55）mm 对（48．74±5．87）mm;房颤持续时间较长,为（81．83±45．75）个月对（53．16±40．23）个月;左心房内径较大,为（49．85±6．82）mm 对（46．77±5．83）mm,P 均＜0．01。多因素 COX 回归分析发现,左心房内径增大（OR＝1．01,95％CI：1．01～1．28,P ＜0．05）,右心房内径增大（OR＝2．85,95％CI：1．15～7．03,P ＜0．05）、房颤持续时间延长（OR＝1．01,95％CI：1．01～1．02,P ＜0．05）是房颤复发的独立危险因素。结论：除左心房内径和房颤持续时间外,右心房内径增大也是已达到消融终点的长程持续性房颤复发的独立危险因素。     

Atrial fibrillation: Catheter ablation

Catheter ablation of atrial fibrillation (AF) has evolved dramatically over the last several years. The initial efforts in the catheter-based management of AF targeted the atrial substrate in an effort to mimic the maze procedure. After the pulmonary veins (PV) were shown to be critical in the initiation and perpetuation of AF, the focus then shifted to a trigger approach in which the PVs and other foci were targeted for ablation. The pendulum then appeared to swing back toward the substrate approach after it was shown that left atrial circumferential ablation afforded improved outcomes in patients with paroxysmal and persistent AF. It has become clear that there are several possible approaches in the catheter ablation of AF, each with its strengths and limitations. It is also becoming evident that not all patients will respond to a single ablation technique and that the ablation protocol is best tailored to suit the individual patient. This article strives to present an evidence-based review of the many techniques, and then offer a practical guide to the catheter ablation of AF.