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心房颤动的脉冲场消融:机制、优势及局限性

Pulsed Field Ablation for Atrial Fibrillation: Mechanisms, Advantages, and Limitations.

作者信息

Jiang Shali, Qian Frank, Ji Shuting, Li Luohong, Liu Qiming, Zhou Shenghua, Xiao Yichao

机构信息

Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China.

Xiangya School of Medicine, Central South University, 410013 Changsha, Hunan, China.

出版信息

Rev Cardiovasc Med. 2024 Apr 8;25(4):138. doi: 10.31083/j.rcm2504138. eCollection 2024 Apr.

Abstract

Pulsed field ablation with irreversible electroporation for the treatment of atrial fibrillation involves tissue-specific and non-thermal energy-induced cell necrosis, which helps avoid complications, such as pulmonary vein stenosis, atrial collateral tissue damage, and extensive atrial structural damage, often encountered with traditional thermal ablation. In existing clinical trials, pulsed field ablation has shown excellent effects on pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation. Pulsed field ablation is easy, simple, and quick and can reduce iatrogenic injury. Therefore, the application of pulsed field ablation technology in the treatment of atrial fibrillation has a promising future. Notably, the adjustment of parameters in pulsed field ablation with different ablation catheter systems can strongly affect the area and depth of the necrotic myocardium, which greatly affects the likelihood of atrial fibrillation recurrence and incidence of adverse complications after ablation. In this paper, we review the mechanisms, advantages, and limitations of pulsed field ablation based on the results of a series of previous studies and provide ideas and directions for future research.

摘要

不可逆电穿孔脉冲场消融治疗心房颤动涉及组织特异性和非热能诱导的细胞坏死,这有助于避免传统热消融常遇到的并发症,如肺静脉狭窄、心房侧支组织损伤和广泛的心房结构损伤。在现有临床试验中,脉冲场消融对阵发性和持续性心房颤动患者的肺静脉隔离显示出优异效果。脉冲场消融操作简便、快捷,可减少医源性损伤。因此,脉冲场消融技术在心房颤动治疗中的应用前景广阔。值得注意的是,不同消融导管系统的脉冲场消融参数调整会强烈影响坏死心肌的面积和深度,这极大地影响心房颤动复发的可能性以及消融后不良并发症的发生率。本文基于一系列先前研究的结果,综述了脉冲场消融的机制、优势和局限性,并为未来研究提供思路和方向。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/242d/11264014/9d876c51ffdf/2153-8174-25-4-138-g1.jpg

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