Reithmann C, Remp T
Medizinische Klinik I, Klinikum Grosshadern, Universität München.
MMW Fortschr Med. 2006 Apr 13;148(15):40-3; quiz 44.
In patients with drug-refractory atrial fibrillation, left-atrial catheter ablation represents a new curative therapeutic option. Segmental ostial or circumferential pulmonary vein isolation can achieve stable sinus rhythm in some 70% of patients with paroxysmal atrial fibrillation but no severe structural heart disease. In patients with chronic atrial fibrillation, complex left-atrial linear, or substrate-oriented ablation strategies may additionally be applied. In patients with cardiac insufficiency or more severe systolic left-ventricular dysfunction, restoration of a stable sinus rhythm through the use of left-atrial catheter ablation can improve the left-ventricular ejection fraction and reduce the severity of cardiac failure. Potential complications of ablation include, in particular, pulmonary veins stenosis, iatrogenic left-atrial tachycardia, thromboembolic events and fatal atrio-esophageal fistulas.
对于药物难治性心房颤动患者，左心房导管消融术是一种新的根治性治疗选择。节段性肺静脉口部隔离或环肺静脉隔离术可使约70%的阵发性心房颤动且无严重结构性心脏病患者恢复稳定的窦性心律。对于慢性心房颤动患者，可能还需要应用复杂的左心房线性或基于基质的消融策略。对于心脏功能不全或收缩期左心室功能更严重障碍的患者，通过左心房导管消融术恢复稳定的窦性心律可提高左心室射血分数并减轻心力衰竭的严重程度。消融的潜在并发症尤其包括肺静脉狭窄、医源性左心房心动过速、血栓栓塞事件和致命的心房食管瘘。
