Tzeis S, Pastromas S, Sikiotis A, Andrikopoulos G
Pacing and Electrophysiology Department, Henry Dunant Hospital Center, Athens, Greece.
Neth Heart J. 2016 Sep;24(9):498-507. doi: 10.1007/s12471-016-0858-y.
Ablation of atrial fibrillation is an established treatment for the management of patients with paroxysmal and persistent atrial fibrillation. The complex pathophysiology of persistent atrial fibrillation has fuelled the concept of adjunctive substrate modification on top of pulmonary vein isolation. However, recent studies have failed to demonstrate additive benefit from complex ablation approaches, thus supporting that standalone pulmonary vein isolation may prove sufficient, at least as the initial ablation strategy in persistent atrial fibrillation. In this premise, the new-generation cryoballoon is an attractive option in this demanding subgroup of patients due to its reliable efficacy in achieving pulmonary vein isolation combined with collateral debulking of the neighbouring atrial myocardium. In this review, we present a critical appraisal of the role of cryoablation in patients with persistent atrial fibrillation, discussing related technical considerations and existing scientific evidence.
房颤消融是阵发性和持续性房颤患者管理的既定治疗方法。持续性房颤复杂的病理生理学推动了在肺静脉隔离基础上进行辅助基质改良的概念。然而，最近的研究未能证明复杂消融方法具有额外益处，从而支持单独的肺静脉隔离可能就足够了，至少作为持续性房颤的初始消融策略。在此前提下，新一代冷冻球囊对于这类要求较高的患者亚组是一个有吸引力的选择，因为它在实现肺静脉隔离方面具有可靠的疗效，同时能对邻近心房心肌进行附带减容。在本综述中，我们对冷冻消融在持续性房颤患者中的作用进行批判性评估，讨论相关技术考量和现有科学证据。
