Zhou L, Keane D, Reed G, Ruskin J
Cardiac Unit, Massachusetts General Hospital and Cardiovascular Biology Laboratory, Harvard School of Public Health, Boston 02114, USA.
J Cardiovasc Electrophysiol. 1999 Apr;10(4):611-20. doi: 10.1111/j.1540-8167.1999.tb00719.x.
Radiofrequency catheter ablation (RFCA) has become established as an effective therapy for the treatment of many cardiac tachyarrhythmias. The principle limitation of conventional RFCA continues to be the risk of thromboembolism. This risk is of particular concern for the ongoing development of the catheter maze procedure for the treatment of atrial fibrillation, which currently involves the creation of extensive linear lesions in the left atrium.
A Medline search of the literature over the last ten years was performed. Focused review of the reported thromboembolic complications of RFCA indicates an overall incidence of 0.6%. However, the risk is increased when ablation is performed in the left heart (1.8% to 2%) and for ventricular tachycardia (2.8%). It is of concern that intravenous heparin and the use of temperature feedback to control radiofrequency current do not eliminate the risk of thromboembolic events.
The thromboembolic complications of RFCA are not eliminated by the treatment of intravenous herapin and mode of temperature control during ablation. Potential approaches to further reduce the risk of thromboembolism include the adjunctive administration of specific inhibitors of platelet activation and aggregation, intraprocedural intracardiac echocardiography, irrigated radiofrequency ablation, and cryoablation catheter systems.
射频导管消融术（RFCA）已成为治疗多种心脏快速性心律失常的有效疗法。传统RFCA的主要局限性仍然是血栓栓塞风险。对于正在开展的用于治疗心房颤动的导管迷宫手术而言，这种风险尤其值得关注，该手术目前需要在左心房制造广泛的线性损伤。
对过去十年的文献进行了医学文献数据库（Medline）检索。对所报道的RFCA血栓栓塞并发症的重点综述表明，总体发生率为0.6%。然而，在左心进行消融时（1.8%至2%）以及对于室性心动过速（2.8%），该风险会增加。令人担忧的是，静脉注射肝素以及使用温度反馈来控制射频电流并不能消除血栓栓塞事件的风险。
RFCA的血栓栓塞并发症不会因静脉注射肝素治疗以及消融过程中的温度控制方式而消除。进一步降低血栓栓塞风险的潜在方法包括辅助给予血小板活化和聚集的特异性抑制剂、术中的心腔内超声心动图、灌注式射频消融以及冷冻消融导管系统。
