Joza Jacqueline, Burri Haran, Andrade Jason G, Linz Dominik, Ellenbogen Kenneth A, Vernooy Kevin
Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada.
Cardiology Department, University Hospital of Geneva, Geneva, Switzerland.
Eur Heart J. 2024 Dec 7;45(46):4887-4901. doi: 10.1093/eurheartj/ehae656.
Despite key advances in catheter-based treatments, the management of persistent atrial fibrillation (AF) remains a therapeutic challenge in a significant subset of patients. While success rates have improved with repeat AF ablation procedures and the concurrent use of antiarrhythmic drugs, the likelihood of maintaining sinus rhythm during long-term follow-up is still limited. Atrioventricular node ablation (AVNA) has returned as a valuable treatment option given the recent developments in cardiac pacing. With the advent of conduction system pacing, AVNA has seen a revival where pacing-induced cardiomyopathy after AVNA is felt to be overcome. This review will discuss the role of permanent pacemaker implantation and AVNA for AF management in this new era of conduction system pacing. Specifically, this review will discuss the haemodynamic consequences of AF and the mechanisms through which 'pace-and-ablate therapy' enhances outcomes, analyse historical and more recent literature across various pacing methods, and work to identify patient groups that may benefit from earlier implementation of this approach.
尽管基于导管的治疗取得了关键进展，但在相当一部分患者中，持续性心房颤动（AF）的管理仍然是一项治疗挑战。虽然重复房颤消融手术和同时使用抗心律失常药物提高了成功率，但在长期随访中维持窦性心律的可能性仍然有限。鉴于心脏起搏的最新进展，房室结消融（AVNA）已再次成为一种有价值的治疗选择。随着传导系统起搏的出现，AVNA得以复兴，人们认为它克服了AVNA术后的起搏诱导性心肌病。本综述将讨论在传导系统起搏的新时代，永久起搏器植入和AVNA在房颤管理中的作用。具体而言，本综述将讨论房颤的血流动力学后果以及“起搏并消融疗法”改善治疗效果的机制，分析各种起搏方法的历史和最新文献，并努力确定可能从早期实施这种方法中受益的患者群体。
