Wittkampf F H M, Derksen R, Wever E F D, Simmers T A, Boersma L V A, Vonken E P A, Velthuis B K, Sreeram N, Rensing B J, Cramer M J
Neth Heart J. 2002 May;10(5):241-244.
In selected patients with atrial fibrillation, the fibrillation episodes may be initiated by single or short bursts of ectopy often originating from one or more pulmonary veins (PVs). Therefore, electrical isolation of these veins by catheter ablation is currently being explored as a treatment modality for patients with paroxysmal and even more permanent types of atrial fibrillation. At present, two different techniques are used: 1) selective ablation of electrical connections between left atrium and myocardial sleeves inside the PVs; and 2) contiguous encircling lesions around and outside the PV ostia. With both techniques, moderate to high success rates have been reported with a limited follow-up duration. Both types of procedure are very complex and require a highly skilful team. With the variable anatomy of the PVs, non-invasively acquired angiographic images may serve as a roadmap for catheter manipulation. Modern three-dimensional catheter navigation techniques can be applied to facilitate accurate catheter positioning with limited fluoroscopic exposure. Experimental and clinical research is needed to define patient selection criteria.
在部分心房颤动患者中，房颤发作可能由单个或短阵的异位搏动引发，这些异位搏动常起源于一条或多条肺静脉（PVs）。因此，目前正在探索通过导管消融实现这些肺静脉的电隔离，以此作为阵发性乃至更持久型心房颤动患者的一种治疗方式。目前，使用了两种不同的技术：1）选择性消融左心房与肺静脉内心肌袖套之间的电连接；2）在肺静脉开口周围及开口外形成连续的环形损伤。采用这两种技术，在有限的随访期内均报告了中度至高度的成功率。这两种手术都非常复杂，需要一个技术高超的团队。鉴于肺静脉解剖结构的多样性，非侵入性获取的血管造影图像可作为导管操作的路线图。现代三维导管导航技术可用于在有限的透视曝光下促进导管的精确放置。需要开展实验和临床研究来确定患者选择标准。
