快慢综合征起搏与消融治疗的个体化选择

Individual therapy of pacing and ablation for tachy-brady syndrome

心脏起搏器植入联合抗心律失常药物被广泛应用于快慢综合征患者的治疗,但起搏器相关并发症及药物不良反应影响了患者的临床获益。随着导管技术的发展,回顾性研究表明,多数快慢综合征患者接受心房颤动(房颤)导管消融后,不再需要起搏器植入治疗。但是,快慢综合征的病因复杂,房颤只是其中之一,且基于肺静脉隔离的房颤消融手术有一定复发风险,故消融治疗并不能适用于所有快慢综合征患者。本文旨在通过总结快慢综合征起搏与消融治疗的研究进展,以期为该疾病治疗方案的个体化选择提供方向。

Pacemaker implantation plus anti-arrhythmia drugs(AADs) was widely indicated for the therapy of tachy-brady syndrome, but pacemaker-related complications and side effects of AADs reduced the clinical benefits of this strategy. With the development of catheter technology, several retrospective trials indicated that catheter ablation for atrial fibrillation can avoid pacemaker implantation in patients with tachy-brady syndrome. However, the etiologies of tachy-brady syndrome are various and complicated, and atrial fibrillation is just one of them. The recurrence risk after catheter ablation based on pulmonary vein isolation cannot be ignored, and it could hardly apply to all patients with tachy-brady syndrome. This article aims to summarize the research about catheter ablation or pacing therapy for tachy-brady syndrome, which may provide the direction of individual therapy for this disease.