Dai Shi-mo, Zhang Shu, Chu Jian-min, Guo Ying-hua, Chen Ke-ping, Yao Shu yuan
Center of Arrhythmia Diagnosis and Treatment, Department of Cardiology, Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, PR China.
Med Hypotheses. 2007;69(4):767-72. doi: 10.1016/j.mehy.2007.02.016. Epub 2007 May 1.
The development of atrial fibrillation ablation has revolutionized the field of antiarrhythmic treatment by reducing the recurrence of atrial fibrillation (AF) significantly in patients with paroxysmal atrium fibrillation (PAF). However, the effect of ablation on the patients with persistent atrial fibrillation (PeAF) is not as good as it on PAF. Although doctors have created a series of ablation strategy, they still cannot treat PeAF effectively. This phenomenon is caused by structural remodeling and electrical remodeling of atrium during the long period of AF. Many experimental have demonstrated remodeling of atrium correlated with high level of angiotensin in atrial tissue, and blockade of renin-angiotensin system (RAS) through angiotensin-converting-enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) can reverse atrial remodeling. Clinical studies also confirmed that blockade of RAS can prevent AF effectively. Thus, for the object of treating PeAF effectively, we can combine the circumferential pulmonary vein isolation with blockade of RAS treatment, this combined strategy eliminate the trigger (pulmonary vein potential ) of AF and reverse the atrial remodeling, may be have a good effect on PeAF.
心房颤动消融术的发展通过显著降低阵发性心房颤动（PAF）患者心房颤动（AF）的复发率，彻底改变了抗心律失常治疗领域。然而，消融术对持续性心房颤动（PeAF）患者的效果不如对PAF患者的效果好。尽管医生已经制定了一系列消融策略，但他们仍然无法有效治疗PeAF。这种现象是由长期房颤期间心房的结构重塑和电重塑引起的。许多实验表明，心房重塑与心房组织中高水平的血管紧张素相关，通过血管紧张素转换酶抑制剂（ACEIs）或血管紧张素II受体阻滞剂（ARBs）阻断肾素-血管紧张素系统（RAS）可以逆转心房重塑。临床研究也证实，阻断RAS可以有效预防房颤。因此，为了有效治疗PeAF，我们可以将环肺静脉隔离与RAS阻断治疗相结合，这种联合策略消除了房颤的触发因素（肺静脉电位）并逆转心房重塑，可能对PeAF有良好效果。
