Schricker Amir A, Zaman Junaid
Department of Cardiovascular Medicine, University of California San Diego Medical Center, San Diego, US.
Department of Cardiovascular Medicine, Stanford Medicine, Stanford, California, US.
Arrhythm Electrophysiol Rev. 2015 May;4(1):47-52. doi: 10.15420/aer.2015.4.1.47. Epub 2015 May 30.
Atrial fibrillation (AF) ablation is increasingly used to maintain sinus rhythm yet its results are sub-optimal, especially in patients with persistent AF or prior unsuccessful procedures. Attempts at improvement have often targeted substrates that sustain AF after it is triggered, yet those mechanisms are debated. Many studies now challenge the concept that AF is driven by self-sustaining disordered wavelets, showing instead that localised drivers (rotors) may drive disorder via a process known as fibrillatory conduction. Novel mapping using wide-area recordings, physiological filtering and phase analysis demonstrates rotors in human AF. Contact mapping with focal impulse and rotor modulation (FIRM) shows that localised ablation at sources can improve procedural success in many populations on long-term follow up and some newer approaches to rotor mapping are qualitatively similar. This review critically evaluates the data on rotor mapping and ablation, which advances our conceptual understanding of AF and holds the promise of substantially improving ablative outcomes in patients with persistent AF.
心房颤动（AF）消融术越来越多地用于维持窦性心律，但其结果并不理想，尤其是在持续性AF患者或既往手术失败的患者中。改善的尝试通常针对触发AF后维持AF的基质，但这些机制存在争议。现在许多研究对AF由自我维持的紊乱小波驱动这一概念提出了挑战，相反，研究表明局部驱动因素（转子）可能通过一种称为颤动传导的过程导致紊乱。使用广域记录、生理滤波和相位分析的新型标测显示了人类AF中的转子。采用局灶性冲动和转子调制（FIRM）的接触标测表明，在长期随访中，对源头进行局部消融可以提高许多人群的手术成功率，并且一些更新的转子标测方法在质量上是相似的。本综述批判性地评估了关于转子标测和消融的数据，这推进了我们对AF的概念理解，并有望显著改善持续性AF患者的消融结果。
