Hong Kathryn Lauren, Borges Jazlyn, Glover Benedict
Cardiology, University of Toronto, Toronto, Canada.
Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada.
Open Heart. 2020 May;7(1). doi: 10.1136/openhrt-2019-001207.
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, with a prevalence that increases alongside the ageing population worldwide. The management of AF involves restoration of sinus rhythm through antiarrhythmic drug therapy. Yet, these medications have only modest efficacy in achieving long-term success, have not shown to result in a mortality benefit, are frequently not tolerated and have associated adverse side effects. Therefore, catheter ablation has become a valuable treatment approach for AF and even a viable first-line strategy in select cases. Traditionally, the combination of radiofrequency energy and a three-dimensional electroanatomical mapping system has been used to guide catheter ablation for AF. However, single-procedural efficacy and long-term outcomes still remain suboptimal for many patients, particularly those with persistent or long-standing AF. Recent advances in ablation technology and strategy, therefore, provide new procedural approaches for catheter-based treatment with the aim of overcoming current challenges in procedural duration and overall success. The aim of this paper was to provide an updated review of the current practices and techniques relating to ablation for AF and to compare the use of these strategies for paroxysmal and persistent AF.
心房颤动（AF）是临床实践中最常见的心律失常，其患病率随着全球人口老龄化而增加。房颤的治疗包括通过抗心律失常药物治疗恢复窦性心律。然而，这些药物在实现长期成功方面疗效有限，未显示出能带来死亡率获益，常不被耐受且有相关副作用。因此，导管消融已成为房颤的一种重要治疗方法，甚至在某些情况下是可行的一线策略。传统上，射频能量与三维电解剖标测系统相结合用于指导房颤的导管消融。然而，对于许多患者，尤其是持续性或长期房颤患者，单次手术的疗效和长期预后仍不理想。因此，消融技术和策略的最新进展为基于导管的治疗提供了新的手术方法，旨在克服当前手术时间和总体成功率方面的挑战。本文的目的是对当前房颤消融的实践和技术进行更新综述，并比较这些策略在阵发性和持续性房颤中的应用。
