Southlake Regional Health Centre, Newmarket, Ontario, Canada.
Can J Cardiol. 2011 Jan-Feb;27(1):60-6. doi: 10.1016/j.cjca.2010.11.011.
Catheter ablation of atrial fibrillation (AF) offers a promising treatment for the maintenance of sinus rhythm in patients for whom a rhythm control strategy is desired. While the precise mechanisms of AF are incompletely understood, there is substantial evidence that in many cases (particularly for paroxysmal AF), ectopic activity most commonly located in and around the pulmonary veins of the left atrium plays a central role in triggering and/or maintaining arrhythmic episodes. Catheter ablation involves electrically disconnecting the pulmonary veins from the rest of the left atrium to prevent AF from being triggered. Further substrate modification may be required in patients with more persistent AF. Successful ablation of AF has never been shown to alter mortality or obviate the need for oral anticoagulation; thus, the primary indication for this procedure should be improvement of symptoms caused by AF. The success rate of catheter ablation for AF is superior to the efficacy of antiarrhythmic drugs, but success is still in the range of 75%-90% after 2 procedures. Ablation is also associated with a complication rate of 2%-3%. Thus, ablation should primarily be used as a second-line therapy after failure of antiarrhythmic drugs. In contrast to AF, catheter ablation of atrial flutter has a higher success rate with a smaller incidence of complications. Thus, catheter ablation for atrial flutter may be considered a first-line alternative to antiarrhythmic drugs.
导管消融术治疗心房颤动（房颤）为希望节律控制的患者提供了维持窦性心律的有效方法。尽管房颤的确切机制尚不完全清楚，但有大量证据表明，在许多情况下（特别是阵发性房颤），异位活动最常见于左心房的肺静脉及其周围，在触发和/或维持心律失常发作中起着核心作用。导管消融术通过电隔离肺静脉与左心房的其余部分，以防止房颤被触发。对于持续性房颤患者，可能需要进一步的基质修正。房颤消融术的成功从未被证明能改变死亡率或避免口服抗凝的需要；因此，该手术的主要适应证应为改善房颤引起的症状。导管消融术治疗房颤的成功率优于抗心律失常药物，但在 2 次手术后，成功率仍在 75%-90%之间。消融术也与 2%-3%的并发症发生率相关。因此，消融术应主要作为抗心律失常药物治疗失败后的二线治疗方法。与房颤不同，导管消融术治疗心房扑动的成功率更高，并发症发生率更低。因此，导管消融术治疗心房扑动可被视为抗心律失常药物的一线替代方法。
