Mathew Sunil T, Po Sunny S
Cardiovascular Section, Department of Veterans Affairs Medical Center, Oklahoma City, OK.
Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
J Innov Card Rhythm Manag. 2017 Oct 15;8(10):2874-2885. doi: 10.19102/icrm.2017.081004. eCollection 2017 Oct.
Careful patient selection and optimization of the management of active medical conditions prior to proceeding with catheter ablation for atrial fibrillation (AF) is critical to reducing complications and improving ablation success. AF ablation performed on patients who have not been offered appropriate antiarrhythmic drug therapy must be tempered with the procedure risks, particularly for those patients having multiple comorbidities. The inability to comply with systemic anticoagulation for thromboembolic prophylaxis in AF is a contraindication to AF ablation, as premature termination of anticoagulation therapy can lead to catastrophic thromboembolic complications. Successful pulmonary vein isolation (PVI), the cornerstone of AF ablation, is demonstrated by entrance and exit block post ablation, with sustained absence of atrium-to-pulmonary vein conduction in both directions. Beyond PVI, there is no consensus for other endpoints for AF ablation, particularly in patients with persistent or longstanding persistent AF. Complications of PVI for AF have decreased in recent years as technology and knowledge in this field has evolved; however, the risks of cardiac tamponade, thromboembolic complications, esophageal injury, and pulmonary vein stenosis may still be formidable.
在进行房颤导管消融术前，仔细选择患者并优化对活动性内科疾病的管理对于减少并发症和提高消融成功率至关重要。对未接受适当抗心律失常药物治疗的患者进行房颤消融时，必须权衡手术风险，尤其是对于那些有多种合并症的患者。房颤患者无法遵行全身抗凝以预防血栓栓塞是房颤消融的禁忌证，因为过早终止抗凝治疗可能导致灾难性的血栓栓塞并发症。成功的肺静脉隔离（PVI）是房颤消融的基石，消融术后通过入口和出口阻滞得以证实，心房与肺静脉双向传导持续消失。除了PVI，对于房颤消融的其他终点尚无共识，尤其是在持续性或长期持续性房颤患者中。近年来，随着该领域技术和知识的发展，房颤PVI的并发症有所减少；然而，心包填塞、血栓栓塞并发症、食管损伤和肺静脉狭窄的风险可能仍然很大。
