消融法治疗心房颤动的现状及前景

Radiofrequency Ablation for Atrial Fibrillation

从上世纪80年代Cox率先开展外科迷宫手术治疗心房颤动开始,心房颤动的射频消融从Swartz线性消融模拟迷宫手术,发展到Haissaguerre的方式为代表的局灶性心房颤动点消融、肺静脉口节段性消融以及Pappone的方式为代表的左心房壁环形肺静脉消融。从消融房室交界区阻断房室传导,植入永久性起搏器和房室结改良术,发展到心房壁的线性消融,肺静脉的点状环状消融和环肺静脉左房消融。由于心房颤动的发病机制复杂,左右心房及肺静脉均可成为异位起搏点或折返部位,加之心房和肺静脉的管壁薄,致使标测消融部位,确定消融范围以及消融损伤组织的深浅均不易掌握。现就消融法治疗心房颤动的操作方法以及目前的现状与前景综述如下。

Atrial fibrillation treatments have being developed from Maze surgery introduced by James Cox in the late 80g of the last century to Swartz linear ablation, local ablation of Haissaguerre, segmental pulmonary vein ostial ablation and to circumferential pulmonary vein ablation of Pappone,from the atrioventricular junctional area to atrial wall and pulmonary vein. However,the mechanism of atrial fibrillation is very complex,both atrials and pulmonary vein maybe become ectopic pacemakers or reentrant circuits,and the wall of the atriums and pulmonary veins are thin, so it is too difficulty to mark the ablation target sites, areas and the depth. We will summarize operation ,current status and prospects of radiofrequeney ablation for atrial fibrillation.