Manolis Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
J Thorac Dis. 2017 Mar;9(3):E313-E321. doi: 10.21037/jtd.2017.02.74.
Over the recent years, the advent of single-shot techniques, such as circular catheter and cryoballoon ablation, has ushered in a new era in the catheter ablation approach and rhythm control strategies of patients with atrial fibrillation (AF). These techniques make it easier to navigate the heart and have the potential to decrease the threshold for, expand the access to, and increase patient and physician acceptance of rhythm-control therapies, that may lead to reduction of the AF disease burden and its socioeconomic impact. Due to technical issues the circular catheter technique is lagging behind, however the cryoballoon approach is progressing at a faster pace both in the field of technical advancements and clinical studies, all contributing to its rapid penetration in the electrophysiological community and rhythm management approaches toward the commonest cardiac arrhythmia. Comparative studies of the conventional point-by-point radiofrequency (RF) ablation technique and the cryoablation approach to pulmonary vein isolation (PVI), which constitutes the cornerstone of all ablation methods, seem to favor the cryoablation technique in certain aspects. The results of current studies converge in their conclusion that cryoablation employing current generation cryoballoons is a simplified and faster method compared to the conventional technique in achieving effective and durable PVI. Furthermore, investigators have recently proposed particular tips and parameters to serve as reliable predictors of successful and durable PVI that may enhance the clinical success of this single-shot ablation technique. These issues will be discussed in this overview and placed into perspective.
近年来，诸如环形导管和冷冻球囊消融等单次消融技术的出现，开创了心房颤动（AF）患者导管消融方法和节律控制策略的新时代。这些技术使心脏操作更加容易，有可能降低节律控制治疗的门槛、扩大其可及性并提高患者和医生对该治疗的接受度，这可能会减轻房颤疾病负担及其社会经济影响。然而，由于技术问题，环形导管技术发展滞后，而冷冻球囊方法在技术进步和临床研究领域都在更快地发展，所有这些都促使其在电生理学界迅速普及，并推动了针对最常见心律失常的节律管理方法的发展。对构成所有消融方法基石的肺静脉隔离（PVI）的传统逐点射频（RF）消融技术和冷冻消融方法进行的比较研究，在某些方面似乎更青睐冷冻消融技术。当前研究结果一致得出结论，与传统技术相比，采用新一代冷冻球囊的冷冻消融是一种实现有效且持久的肺静脉隔离的更简化、更快速的方法。此外，研究人员最近提出了一些特定的技巧和参数，作为成功且持久的肺静脉隔离的可靠预测指标，这可能会提高这种单次消融技术的临床成功率。这些问题将在本综述中进行讨论并加以阐述。
