Hocini Mélèze, Pasquié Jean-Luc, Jaïs Pierre, Haïssaguerre Michel
Service de cardiologie, Hôpital cardiologique du Haut-Levêque, 33604 Pessac Cedex.
Rev Prat. 2004 Feb 15;54(3):291-7.
The development of radiofrequency catheter ablation has dramatically changed the therapeutic approach of cardiac arrhythmias. All atrial rhythm disturbances are now amenable to ablative strategy. Ablation has become the first-line therapy for atrial flutter. Atrial fibrillation, a major factor of morbidity and mortality, is now a target for this radical treatment. Ablation of pulmonary vein foci, eventually associated to atrial linear lesions, raises the possibility of suppressing atrial fibrillation. The success rate is now as high as 70 to 85%, depending on the form of atrial fibrillation. For atrioventricular reentrant tachycardia either nodal or over an accessory pathway, ablation is the reference treatment with success rates of 99%. All symptomatic Wolff-Parkinson-White syndromes can be definitely cured by this technique. At the ventricular level, the procedures are often more complexes, due to advanced cardiomyopathy. However, most of sustained ventricular tachycardias can be cured by ablation. The success rates are somewhat lower (about 80%). The challenge for the next years is ablation of premature ventricular beats initiating ventricular fibrillation. The technique is also improving from day-to-day (88% success rate) and makes rise the hope of curing sudden death.
射频导管消融术的发展极大地改变了心律失常的治疗方法。现在，所有的房性节律紊乱都适合采用消融策略。消融已成为心房扑动的一线治疗方法。心房颤动作为发病率和死亡率的一个主要因素，目前已成为这种根治性治疗的靶点。肺静脉病灶的消融，最终与心房线性病变相关，增加了抑制心房颤动的可能性。根据心房颤动的类型，目前成功率高达70%至85%。对于房室折返性心动过速，无论是通过房室结还是通过旁路，消融都是参考治疗方法，成功率为99%。所有有症状的预激综合征都可以通过这种技术得到明确治愈。在心室层面，由于晚期心肌病，手术往往更为复杂。然而，大多数持续性室性心动过速可以通过消融治愈。成功率略低（约80%）。未来几年的挑战是消融引发心室颤动的室性早搏。这项技术也在日益改进（成功率88%），并带来了治愈猝死的希望。
