Westdeutsches Herz- und Gefäßzentrum Essen, Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Germany.
partner site Munich Heart Alliance, DZHK (German Centre for Cardiovascular Research), 80802, Munich, Germany.
Herzschrittmacherther Elektrophysiol. 2021 Mar;32(1):9-13. doi: 10.1007/s00399-021-00744-9. Epub 2021 Feb 3.
Premature atrial complexes (PACs) are a common finding in patients with structural heart disease, as well as in healthy subjects. In addition to the clinical spectrum ranging from asymptomatic patients to irritating palpitations, PACs are suggested to be associated with an increased risk of atrial fibrillation and stroke. Medical treatment leads to a significant reduction in PACs with clear symptom relief in a large proportion of patients, but is limited in cases of PACs that are refractory to antiarrhythmic drug (AAD) treatment. Furthermore, proarrhythmic effects of AAD or the patient's refusal of AAD treatment due to side effects need to be considered. Ablation of PACs is a good alternative to medical therapy with a comparable safety profile and at least comparable efficacy. In recent years, ultra-high-density (UHD) mapping with multiple improvements for successful ablation has been evolving. Before the introduction of UHD mapping, ablation strategies included activation mapping with single-tip catheters or conventional mapping aiming for the earliest activation of the PAC locally, with the earliest activation suspected to be the origin of the PAC and targeted by radiofrequency (RF) ablation. Using UHD mapping, a three-dimensional local activation map of the atrium can be acquired, identifying the point of earliest activation within the high-resolution map. PAC ablation has therefore developed into a true alternative for the treatment of symptomatic PACs.
房性期前收缩（PACs）是结构性心脏病患者以及健康受试者的常见发现。除了从无症状患者到刺激性心悸的临床表现谱外，PACs 还与心房颤动和中风风险增加相关。药物治疗可显著减少 PACs 的发生，并使大多数患者的症状明显缓解，但对于对抗心律失常药物（AAD）治疗有反应的 PACs 病例则有限。此外，还需要考虑 AAD 的致心律失常作用或患者因副作用而拒绝 AAD 治疗。与药物治疗相比，消融术是一种很好的替代方法，具有相似的安全性和至少相当的疗效。近年来，随着成功消融的多项改进，超高密度（UHD）标测技术不断发展。在引入 UHD 标测之前，消融策略包括使用单尖端导管进行激活标测或常规标测，以寻找 PAC 局部最早的激活点，最早的激活点被怀疑是 PAC 的起源，并通过射频（RF）消融进行靶向治疗。使用 UHD 标测，可以获得心房的三维局部激活图，在高分辨率图中识别最早激活的点。因此，PAC 消融已成为治疗有症状的 PACs 的一种真正的替代方法。
