Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK.
Postgrad Med J. 2012 Oct;88(1044):604-11. doi: 10.1136/postgradmedj-2012-130896. Epub 2012 Jul 3.
Atrial fibrillation (AF) is the most common arrhythmia. For many years, treatment was predominantly pharmacological. The identification of signals from the pulmonary veins as critical to AF in many patients led to catheter ablation targeting these signals. Catheter ablation is more effective than antiarrhythmic drugs at restoring sinus rhythm, and may improve mortality, morbidity and quality of life in patients with symptomatic AF. There is evidence to suggest that catheter ablation would be even more beneficial if undertaken earlier in the disease process. Cost effectiveness of catheter ablation remains under assessment, but it does meet the NICE definition of cost efficacy and the figure improves as stroke risk rises. It is true that long-term data are lacking. However, until results of current long-term studies become available, ablation will continue to be reserved predominantly for patients with drug-refractory, symptomatic AF.
心房颤动(AF)是最常见的心律失常。多年来,治疗主要是药物治疗。许多患者的肺静脉信号被确定为 AF 的关键因素,这导致了针对这些信号的导管消融。与抗心律失常药物相比,导管消融更有效地恢复窦性节律,并且可能改善有症状的 AF 患者的死亡率、发病率和生活质量。有证据表明,如果在疾病过程的早期进行导管消融,效果会更好。导管消融的成本效益仍在评估中,但它符合 NICE 对成本效益的定义,并且随着中风风险的增加,这一数字会有所改善。确实,长期数据还缺乏。然而,在当前长期研究的结果公布之前,消融将继续主要保留给药物难治性、有症状的 AF 患者。