Feld G K
Department of Medicine, University of California, San Diego, USA.
Am J Cardiol. 1999 Nov 4;84(9A):115R-124R. doi: 10.1016/s0002-9149(99)00762-6.
The field of clinical cardiac electrophysiology has evolved dramatically over the last 30 years, beginning with description of the first His bundle recording in 1969. Subsequently, in the early 1970s, more sophisticated diagnostic electrophysiologic techniques were developed to diagnose and guide drug treatment of arrhythmias. These diagnostic techniques were further advanced during the late 1970s and 1980s to electrically map arrhythmias and guide their surgical ablation. Surgical treatments of both supraventricular and ventricular arrhythmias proliferated in the 1970s and 1980s, with overall excellent results. However, because of the morbidity and mortality associated with arrhythmia surgery, it was ultimately replaced in the 1990s by radiofrequency catheter ablation (RFCA) for treatment of most forms of supraventricular tachycardia and idiopathic ventricular tachycardia, and by the automatic implantable cardioverter defibrillator (ICD) for treatment of life-threatening ventricular arrhythmias associated with coronary artery disease and dilated cardiomyopathy. At present, the only arrhythmias that cannot be reliably and safely cured by RFCA are chronic atrial fibrillation and life-threatening ventricular arrhythmias. For chronic atrial fibrillation, new catheter designs are being developed to create linear ablation lines mimicking the curative MAZE operation. For life-threatening ventricular arrhythmias, the ICD has been increasingly utilized as transvenous lead systems and smaller devices have been developed. In the next millennium, new developments that may be expected for treatment of atrial fibrillation and life-threatening ventricular arrhythmias include catheter systems for linear RFCA of atrial fibrillation, ICDs for both atrial and ventricular defibrillation, and biventricular pacing ICDs for patients with congestive heart failure.
在过去30年里，临床心脏电生理学领域取得了巨大的发展，始于1969年首次记录希氏束。随后，在20世纪70年代早期，更先进的诊断电生理技术得以开发，用于诊断和指导心律失常的药物治疗。这些诊断技术在20世纪70年代末和80年代进一步发展，用于心律失常的电标测并指导其手术消融。20世纪70年代和80年代，室上性和室性心律失常的手术治疗迅速增加，总体效果良好。然而，由于心律失常手术相关的发病率和死亡率，在20世纪90年代，它最终被射频导管消融（RFCA）所取代，用于治疗大多数形式的室上性心动过速和特发性室性心动过速，以及被自动植入式心脏复律除颤器（ICD）用于治疗与冠状动脉疾病和扩张型心肌病相关的危及生命的室性心律失常。目前，RFCA不能可靠且安全治愈的唯一心律失常是慢性心房颤动和危及生命的室性心律失常。对于慢性心房颤动，正在开发新的导管设计，以创建模仿治愈性迷宫手术的线性消融线。对于危及生命的室性心律失常，ICD的使用越来越多，同时也开发了经静脉导联系统和更小的设备。在新的千年里，预计用于治疗心房颤动和危及生命的室性心律失常的新进展包括用于心房颤动线性RFCA的导管系统、用于心房和心室除颤的ICD，以及用于充血性心力衰竭患者的双心室起搏ICD。
