Oral Hakan, Chugh Aman, Good Eric, Sankaran Sundar, Reich Stephen S, Igic Petar, Elmouchi Darryl, Tschopp David, Crawford Thomas, Dey Sujoya, Wimmer Alan, Lemola Kristina, Jongnarangsin Krit, Bogun Frank, Pelosi Frank, Morady Fred
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
Circulation. 2006 Apr 18;113(15):1824-31. doi: 10.1161/CIRCULATIONAHA.105.601898. Epub 2006 Apr 10.
Because the genesis of atrial fibrillation (AF) is multifactorial and variable, an ablation strategy that involves pulmonary vein isolation and/or a particular set of ablation lines may not be equally effective or efficient in all patients with AF. A tailored strategy that targets initiators and drivers of AF is a possible alternative to a standardized lesion set.
Catheter ablation was performed in 153 consecutive patients (mean age, 56+/-11 years) with symptomatic paroxysmal AF with the use of an 8-mm tip radiofrequency ablation catheter. The esophagus was visualized with barium. The pulmonary veins and left atrium were mapped during spontaneous or induced AF. Arrhythmogenic pulmonary veins were isolated or encircled. If AF was still present or inducible, complex electrograms in the left atrium, coronary sinus, and superior vena cava were targeted for ablation. The end point of ablation was absence of frequent atrial ectopy and spontaneous AF during isoproterenol infusion and noninducibility of AF. Routine energy applications near the esophagus were avoided. During follow-up, left atrial flutter developed in 19% of patients and was still present in 10% at >12 weeks of follow-up. A repeat ablation procedure was performed in 18% of patients. During a mean follow-up of 11+/-4 months, 77% of patients were free from AF and/or atrial flutter without antiarrhythmic drug therapy. Pericardial tamponade or transient neurological events occurred in 2% of procedures.
A tailored ablation strategy that only targets triggers and drivers of AF is feasible and eliminates paroxysmal AF in approximately 80% of patients.
由于心房颤动（AF）的发生是多因素且多变的，涉及肺静脉隔离和/或特定消融线的消融策略在所有AF患者中可能并非同样有效或高效。针对AF的起始因素和驱动因素的个体化策略可能是标准化消融灶的替代方案。
使用8毫米尖端射频消融导管对153例有症状的阵发性AF连续患者（平均年龄56±11岁）进行导管消融。用钡剂显影食管。在自发或诱发AF期间对肺静脉和左心房进行标测。隔离或环绕致心律失常的肺静脉。如果AF仍然存在或可诱发，则将左心房、冠状窦和上腔静脉中的复杂电图作为消融靶点。消融终点是在异丙肾上腺素输注期间无频繁房性早搏和自发AF，且AF不可诱发。避免在食管附近常规施加能量。随访期间，19%的患者发生左心房扑动，在随访>12周时，10%的患者仍有左心房扑动。18%的患者进行了重复消融手术。在平均11±4个月的随访期间，77%的患者在未使用抗心律失常药物治疗的情况下无AF和/或心房扑动。2%的手术发生心包填塞或短暂性神经事件。
仅针对AF触发因素和驱动因素的个体化消融策略是可行的，并且可使约80%的患者消除阵发性AF。
