Department of Cardiology, Royal Adelaide Hospital and the Disciplines of Medicine and Physiology, University of Adelaide, Cardiovascular Research Centre, Adelaide, Australia.
Heart Rhythm. 2010 Jun;7(6):835-46. doi: 10.1016/j.hrthm.2010.01.017. Epub 2010 Jan 22.
Ablation of long-standing persistent atrial fibrillation (AF) is highly variable, with differing techniques and outcomes.
The purpose of this study was to undertake a systematic review of the literature with regard to the impact of ablation technique on the outcomes of long-standing persistent AF ablation.
A systematic search of the contemporary English scientific literature (from January 1, 1990 to June 1, 2009) in the PubMed database identified 32 studies on persistent/long-standing persistent or long-standing persistent AF ablation (including four randomized controlled trials). Data on single-procedure, drug-free success, multiple procedure success, and pharmaceutically assisted success at longest follow-up were collated.
Four studies performed pulmonary vein isolation alone (21%-22% success). Four studies performed pulmonary vein antrum ablation with isolation (PVAI; n = 2; 38%-40% success) or without confirmed isolation (PVA; n = 2; 37%-56% success). Ten studies performed linear ablation in addition to PVA (n = 5; 11%-74% success) or PVAI (n = 5; 38%-57% success). Three studies performed posterior wall box isolation (n = 3; 44%-50% success). Five studies performed complex fractionated atrial electrogram ablation (n = 5; 24%-63% success). Six studies performed complex fractionated atrial electrogram ablation as an adjunct to PVA (n = 2; 50%-51% success), PVAI (n = 3; 36%-61% success), or PVAI and linear (n = 1; 68% success) ablation. Five studies performed the stepwise ablation approach (38%-62% success).
The variation in success within and between techniques suggests that the optimal ablation technique for long-standing persistent AF is unclear. Nevertheless, long-standing persistent AF can be effectively treated with a composite of extensive index catheter ablation, repeat procedures, and/or pharmaceuticals.
消融长期持续性心房颤动（AF）的效果差异很大，不同的技术和结果也不同。
本研究旨在对长期持续性 AF 消融的消融技术对结果的影响进行系统的文献综述。
在 PubMed 数据库中对 1990 年 1 月 1 日至 2009 年 6 月 1 日的当代英文科学文献进行系统搜索，确定了 32 项关于持续性/长期持续性或长期持续性 AF 消融的研究（包括 4 项随机对照试验）。对单步、无药物成功、多次成功和最长随访时药物辅助成功的数据进行了整理。
4 项研究单独进行肺静脉隔离（成功率为 21%-22%）。4 项研究进行肺静脉窦消融加隔离（PVAI；n=2；成功率为 38%-40%）或不加确认隔离（PVA；n=2；成功率为 37%-56%）。10 项研究在 PVA 或 PVAI 之外进行线性消融（n=5；成功率为 11%-74%）。3 项研究进行后侧壁盒隔离（n=3；成功率为 44%-50%）。5 项研究进行复杂碎裂心房电图消融（n=5；成功率为 24%-63%）。6 项研究将复杂碎裂心房电图消融作为 PVA（n=2；成功率为 50%-51%）、PVAI（n=3；成功率为 36%-61%）或 PVAI 和线性消融（n=1；成功率为 68%）的辅助治疗。5 项研究采用逐步消融方法（成功率为 38%-62%）。
不同技术之间和之内的成功率差异表明，对于长期持续性 AF，最佳的消融技术尚不清楚。然而，长期持续性 AF 可以通过广泛的指数导管消融、重复手术和/或药物的组合进行有效治疗。
