Wats Karan, Kiser Andy, Makati Kevin, Sood Nitesh, DeLurgio David, Greenberg Yisachar, Yang Felix
Maimonides Medical Center, Brooklyn, New York, NY, US.
St Clair Cardiovascular Surgical Associates, Pittsburgh, PA, US.
Arrhythm Electrophysiol Rev. 2020 Aug;9(2):88-96. doi: 10.15420/aer.2019.20.
The treatment of AF has evolved over the past decade with increasing use of catheter ablation in patients refractory to medical therapy. While pulmonary vein isolation using endocardial catheter ablation has been successful in paroxysmal AF, the results have been more controversial in patients with long-standing persistent AF where extrapulmonary venous foci are increasingly recognised in the initiation and maintenance of AF. Hybrid ablation is the integration of minimally invasive epicardial ablation with endocardial catheter ablation, and has been increasingly used in this population with better results. The aim of this article was to analyse and discuss the evidence for the integration of catheter and minimally invasive surgical approaches to treat AF with specific focus on convergent ablation and exclusion of the left atrial appendage using a surgically applied clip.
在过去十年中，房颤的治疗方法不断发展，越来越多地对药物治疗无效的患者采用导管消融术。虽然采用心内膜导管消融术进行肺静脉隔离对阵发性房颤已取得成功，但对于长期持续性房颤患者，其结果更具争议性，因为在房颤的起始和维持过程中，肺外静脉病灶越来越受到认可。杂交消融是将微创的心外膜消融与心内膜导管消融相结合，并且越来越多地应用于这类患者，效果更佳。本文的目的是分析和讨论导管与微创外科手术相结合治疗房颤的证据，特别关注融合消融以及使用手术夹夹闭左心耳。
