慢性房颤的导管消融:时机已经成熟

Catheter Ablation of Chronic Atrial Fibrillation: the time is ripe

心房解剖及电重构基础上的多发子波折返是慢性房颤的维持机制,支持线性消融策略;导管消融有关的操作逐渐标准化;盐水灌注导管和三维标测系统等新器械不断进展;慢性房颤消融策略的争议逐渐减少,采用肺静脉隔离加线性消融者越来越多;消融终点更多的以肺静脉隔离和线性阻滞为主,以直接终止心动过速为终点者减少。慢性房颤的导管消融时机已经成熟。

Multiple wavelet reentry based on atrial anatomical and electrical remodelling is the maintenance mechanism of chronic atrial fibrillation （AF）, which supports the linear ablation strategy. Now the technique for catheter manipulation has become standard and new devices for ablation like irrigated catheter and 3--dimensional mapping system have been improved a lot. The controversies about ablation strategy for chronic AF abate gradually, more and more ablationists do circumferential pulmonary vein ablation plus atrial linear ablation with an endpoint of pulmonary vein isolation and conduction block of all ablated lines other than AF termination directly by ablation. Now the time is ripe for catheter ablation of chronic AF.