Weretka S, Weig H-J, Rüb N, Parade U, Kerst G, Laszlo R, Gawaz M, Schreieck J
Medizinische Klinik III, Universitätsklinikum Tübingen.
Dtsch Med Wochenschr. 2011 Nov;136(47):2434. doi: 10.1055/s-0031-1292817. Epub 2011 Nov 17.
A 71-year-old, male patient was referred to our clinic for paroxysmal palpitations with dyspnoe and fatigue since four years despite pharmacological treatment with flecainide and bisoprolol.
A paroxysmal atrial fibrillation was documented in a 24-hour Holter recording. A bicycle ergometry showed a hypertensive reaction during exercise without any sign of coronary insufficiency. Intracardiac thrombi could by excluded by transesophageal echocardiography.
DIAGNOSIS, TREATMENT AND COURSE: The diagnosos of a drug-refractory paroxysmal atrial fibrillation was made and cryoballoon pulmonary vein isolation was performed. A follow-up 3 months after the ablation disclosed a freedom from atrial fibrillation documented in 7-day Holter recording.
Compared to pharmacological rhythm control, interventional treatment has been established as more effective therapy for paroxysmal atrial fibrillation. However, patients should be referred to the ablation early enough to avoid structural atrial remodeling and thus transition into persistent or permanent atrial fibrillation. New technical developments e.g. cryoballoon catheter-system simplifies the procedure and has been reported to be effective and safe to use for circumferential pulmonary vein isolation. Should the very promising preclinical data on efficacy and safety of cryothermal energy ablation be confirmed by results of ongoing, controlled trials, the catheter ablation may become the fist-line treatment for all patients with paroxysmal atrial fibrillation.
一名71岁男性患者，尽管使用氟卡尼和比索洛尔进行药物治疗，但四年来一直因阵发性心悸伴呼吸困难和疲劳被转诊至我院门诊。
24小时动态心电图记录显示阵发性心房颤动。踏车运动试验显示运动期间出现高血压反应，无任何冠状动脉供血不足迹象。经食管超声心动图排除心内血栓形成。
诊断、治疗与病程：诊断为药物难治性阵发性心房颤动，并进行了冷冻球囊肺静脉隔离术。消融术后3个月随访，7天动态心电图记录显示无房颤发作。
与药物节律控制相比，介入治疗已被确立为阵发性心房颤动更有效的治疗方法。然而，应尽早将患者转诊至消融治疗，以避免心房结构重塑，从而防止转变为持续性或永久性心房颤动。新技术的发展，如冷冻球囊导管系统，简化了手术过程，据报道用于环肺静脉隔离有效且安全。如果正在进行的对照试验结果证实低温能量消融在疗效和安全性方面非常有前景的临床前数据，导管消融可能会成为所有阵发性心房颤动患者的一线治疗方法。
