Pacific Rim Electrophysiology Research Institute, 1700 Cesar Chavez Avenue, Suite 2700, Los Angeles, CA 90033, USA.
J Cardiol. 2010 Jan;55(1):1-12. doi: 10.1016/j.jjcc.2009.11.002. Epub 2009 Dec 16.
Cardiologists and physicians have witnessed a significant change in the management of atrial fibrillation (AF): antiarrhythmic agents are no longer considered more effective than just merely using compounds that control ventricular response of the arrhythmia with anticoagulation in high-risk patients. Catheter ablation has grown into wider acceptance as an important therapeutic modality in treating tachyarrhythmias. And over the past decade, several studies have clearly established that catheter ablation of atrial fibrillation is safe and effective and is an important alternative therapeutic option to the pharmacological approach. In general, there are two approaches to AF ablation: The anatomical approach, the most popular one, relies on isolation of electrical connections of all four pulmonary veins to the left atrium with or without adjuvant ablations, i.e. additional linear ablations. The second approach is the electrogram-guided approach by mapping and targeting areas of complex fractionated atrial electrograms (CFAE) which is the main topic of this review. The myriad pathologies leading to and resulting from AF have led to many theories regarding how substrate should be defined and how to reconcile substrate ablation with trigger ablation. The identification of spatiotemporally stable areas of very low amplitude short cycle length CFAE in a sea of otherwise discrete normal amplitude and relatively longer cycle length electrograms led to ablate the CFAE as a marker of abnormal substrate. This pure substrate-based ablation strategy has resulted in remarkable success, including mortality benefit, even in high-risk patients with very long standing persistent AF. In this review, we discuss in detail the prevailing mechanisms underlying CFAE, how to map and ablate CFAE sites, correlation of CFAE areas to those of ganglionic plexi, clinical outcomes of the approach, and the role of CFAE in the hybrid approach of AF ablation using a combination of pulmonary vein isolation and targeting CFAE areas.
心脏病学家和内科医生已经见证了心房颤动 (AF) 管理的重大变化：抗心律失常药物不再被认为比仅仅使用抗凝药物控制心律失常的室性反应更有效，在高危患者中。导管消融已广泛接受为治疗快速性心律失常的重要治疗方式。在过去的十年中，几项研究清楚地表明，导管消融心房颤动是安全有效的，是药物治疗方法的重要替代治疗选择。一般来说，有两种方法可以进行 AF 消融：解剖学方法是最流行的方法，它依赖于隔离所有四个肺静脉与左心房的电连接，或者不进行辅助消融，即额外的线性消融。第二种方法是通过对复杂碎裂心房电图 (CFAE) 的区域进行映射和靶向的电信号导向方法，这是本综述的主要主题。导致和导致 AF 的多种病理学导致了许多关于如何定义基质以及如何协调基质消融与触发消融的理论。在其他离散的正常幅度和相对较长的周期长度电图中，时空稳定的极低幅度短周期长度 CFAE 区域的识别导致消融 CFAE 作为异常基质的标志物。这种纯粹基于基质的消融策略取得了显著的成功，包括死亡率的降低，即使在具有非常长的持续性 AF 的高危患者中也是如此。在这篇综述中，我们详细讨论了 CFAE 背后的主要机制、如何对 CFAE 区域进行映射和消融、CFAE 区域与神经节丛的相关性、该方法的临床结果以及 CFAE 在使用肺静脉隔离和靶向 CFAE 区域的混合消融方法治疗 AF 中的作用。
