Lemola K, Brunckhorst C, Duru F, Candinas R
Zentrum für Kardiovaskuläre Medizin, Universitätsspital Zürich.
Praxis (Bern 1994). 2003 Jul 30;92(31-32):1298-306. doi: 10.1024/0369-8394.92.31.1298.
Atrial fibrillation is the most frequent arrhythmia with a prevalence of 1.7% in the general population and 5% in the population over 65 year old [1], the prevalence in men over 65 years is even 9.1% [2]. Atrial fibrillation is divided dependent on its frequency in intermittent, persisting and chronic. The symptoms and the clinical course are individually very different. Responsible for the initiation of atrial fibrillation are triggers, which initiate atrial fibrillation, and a substrate, that means an atrial myocardium altered by remodelling, which maintains atrial fibrillation. A curative treatment was not available until recently. Different ablation techniques were developed: Linear, focal ablation techniques and the isolation of pulmonary veins. The observation that atrial fibrillation will maintain only in large atria, led to the linear ablation techniques with the goal of reducing the atria functionally. The linear ablations have however a small value because of low success rates and high complication rates. Arrhythmogenic foci are of crucial importance in the initiation of atrial fibrillation, these foci are mostly located in the pulmonary veins. This observation led to the focal ablation in the pulmonary veins, which was left again because of the limitations, however. For some years the isolation of pulmonary veins is performed at some large centers. This paper summarizes the most important techniques, success rates and complications of the pulmonary vein isolation. The present indication and the preinterventional diagnostics are discussed. Due to the constantly improving success rates and decreasing complication rates (pulmonary vein stenosis, thrombembolie, cardiac tamponades, mortality practically) the pulmonary vein isolation is an alternative possibility of treatment which can be considered for a subgroup of patients with drug-resistant, symptomatic atrial fibrillation.
心房颤动是最常见的心律失常，在普通人群中的患病率为1.7%，在65岁以上人群中为5%[1]，65岁以上男性的患病率甚至高达9.1%[2]。根据发作频率，心房颤动可分为间歇性、持续性和慢性。其症状和临床病程个体差异很大。引发心房颤动的因素包括触发因素（启动心房颤动）和基质（即因重构而改变的心房心肌，维持心房颤动）。直到最近才有了根治性治疗方法。人们开发了不同的消融技术：线性消融技术、局灶性消融技术以及肺静脉隔离术。由于观察到心房颤动仅在大心房中持续存在，因此产生了线性消融技术，目的是在功能上缩小心房。然而，由于成功率低和并发症发生率高，线性消融的价值不大。致心律失常病灶在心房颤动的起始中至关重要，这些病灶大多位于肺静脉。这一观察结果导致了肺静脉局灶性消融，但由于其局限性，这种方法又被放弃了。几年来，一些大型中心一直在进行肺静脉隔离术。本文总结了肺静脉隔离术的最重要技术、成功率和并发症。讨论了目前的适应症和介入前诊断。由于成功率不断提高，并发症发生率不断降低（肺静脉狭窄、血栓栓塞、心脏压塞、死亡率几乎为零），肺静脉隔离术是一种可考虑用于一部分药物难治性、有症状心房颤动患者的替代治疗方法。
