Skanes Allan C, Yee Raymond, Krahn Andrew D, Klein George J
Arrhythmia Service, University of Western Ontario, London, Ontario, Canada.
Card Electrophysiol Rev. 2002 Dec;6(4):383-8. doi: 10.1023/a:1021128207078.
The advent of radiofrequency energy has changed the therapy for supraventricular arrhythmias. Radiofrequency ablation is highly effective and safe. However, the demand for specific ablation lesion characteristic (deep focal lesions or long continuous transmural lesions) has highlighted some of the limitations of radiofrequency as an ablation energy source. Cryothermy as an arrhythmia ablation technology has been well studied and found to be a highly effective and safe technology in the surgical literature. Recently, catheter-based cryoablation has become available. This article reviews some of the unique features of catheter-based cryoablation and highlights some of its potential advantages. Specifically, the ability to reversibly test the functionality of an ablation site prior to the production of a permanent lesion, so called "ice mapping", has obvious appeal. In fact, the ability to ice map para-Hisian pathways or the slow pathway in close proximity to the AV node may make this the technology of choice for such substrates. Recent animal work has re-confirmed the safety of cryothermal ablation within the coronary sinus, in close proximity to epicardial coronary arteries. Also, clinical work suggests that this technology may result in less endothelial disruption and less pulmonary venous stenosis, although this requires confirmation in larger trials. The ultimate role of catheter-based cryoablation remains to be determined. A number of promising aspects of this ablation energy make it an exciting technology.
射频能量的出现改变了室上性心律失常的治疗方法。射频消融术高效且安全。然而，对特定消融病灶特征（深部局灶性病灶或长的连续性透壁病灶）的需求凸显了射频作为消融能量源的一些局限性。冷冻疗法作为一种心律失常消融技术已得到充分研究，并且在外科文献中被发现是一种高效且安全的技术。最近，基于导管的冷冻消融术已经问世。本文回顾了基于导管的冷冻消融术的一些独特特征，并强调了其一些潜在优势。具体而言，在产生永久性病灶之前可逆地测试消融部位功能的能力，即所谓的“冰标测”，具有明显的吸引力。事实上，对希氏束旁路径或靠近房室结的慢径路进行冰标测的能力可能使其成为此类基质的首选技术。最近的动物实验再次证实了在紧邻心外膜冠状动脉的冠状窦内进行冷冻消融的安全性。此外，临床研究表明，尽管这需要在更大规模的试验中得到证实，但该技术可能导致更少的内皮损伤和更少的肺静脉狭窄。基于导管的冷冻消融术的最终作用仍有待确定。这种消融能量的许多有前景的方面使其成为一项令人兴奋的技术。
