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心房颤动的脉冲场导管消融。

Pulsed field catheter ablation in atrial fibrillation.

机构信息

Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx 10467, NY, United States.

Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx 10467, NY, United States.

出版信息

Trends Cardiovasc Med. 2022 Aug;32(6):378-387. doi: 10.1016/j.tcm.2021.07.006. Epub 2021 Jul 28.

Abstract

Catheter ablation (CA) has become the mainstay therapy for the maintenance of sinus rhythm in patients with atrial fibrillation (AF), with pulmonary vein isolation (PVI) the most frequently used treatment strategy. Although several energy sources have been tested (including radiofrequency, cryothermal and laser), these are not devoid of safety issues and in many instances effectiveness is dependent on operator experience. Pulsed field ablation (PFA) is a novel energy source by which high-voltage electric pulses are used to create pores in the cellular membrane (i.e., electroporation), leading to cellular death. The amount of energy required to produce irreversible electroporation is highly tissue dependent. In consequence, a tailored protocol in which specific targeting of the atrial myocardium is achieved while sparing adjacent tissues is theoretically feasible, increasing the safety of the procedure. While large scale clinical trials are lacking, current clinical evidence has demonstrated significant efficacy in achieving durable PVI without ablation related adverse events.

摘要

导管消融 (CA) 已成为维持心房颤动 (AF) 患者窦性心律的主要治疗方法,肺静脉隔离 (PVI) 是最常用的治疗策略。尽管已经测试了几种能源(包括射频、冷冻和激光),但这些能源并非没有安全问题,而且在许多情况下,其有效性取决于操作人员的经验。脉冲场消融 (PFA) 是一种新的能源,它使用高压电脉冲在细胞膜上产生孔(即电穿孔),导致细胞死亡。产生不可逆电穿孔所需的能量与组织高度相关。因此,理论上可以实现一种定制的方案,即在不损伤相邻组织的情况下,有针对性地靶向心房心肌,从而提高手术的安全性。虽然缺乏大规模的临床试验,但目前的临床证据表明,该方法在实现持久的 PVI 而不发生消融相关不良事件方面具有显著疗效。

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