Saoudi N, Koning R, Eltchaninoff H, Cribier A, Letac B
Service de cardiologie (Groupe Vacomed), hôpital Charles-Nicolle, Rouen.
Arch Mal Coeur Vaiss. 1994 Jan;87(1 Spec No):27-34.
Atrial arrhythmias resistant to medical therapy are still a common indication for ablation of the normal atrioventricular conduction pathway (Tawara node and His Bundle). However, the development of catheter techniques of intra-atrial ablation to destroy arrhythmogenic myocardial zones enables radical cure of the arrhythmias with the respect of the nodo-hisian pathway. With respect to common flutter, a number of series, including our own, show a 50 to 75% long-term success rate. We believe that a very high success rate in the ablation of flutter will probably be achieved in a reproducible manner but this will require a more accurate understanding of the tachycardia circuit and technological developments allowing controlled radio-frequency destruction of bigger atrial myocardial zone. Experience of radio-frequency ablation atrial of atrial extrasystoles is more limited than that of flutter and there are fewer published series. Globally, catheter ablation of atrial tachycardia remains a more difficult and a less well codified procedure than that of accessory pathways or of intra-nodal reentry. Radio-frequency ablation in this indication is not without danger in view of the thinness of the atrial wall. We believe that radio-frequency catheter ablation for atrial arrhythmias should, for the moment, be reserved for centres specialised in the techniques of electro-physiological investigation and ablation.
药物治疗无效的房性心律失常仍是消融正常房室传导通路（房室结和希氏束）的常见指征。然而，心房内消融导管技术的发展，能够破坏致心律失常心肌区域，从而在保留房室结 - 希氏束传导通路的情况下根治心律失常。对于常见的心房扑动，包括我们自己的研究在内，多个系列研究显示长期成功率为50%至75%。我们认为，通过可重复的方式在心房扑动消融中实现非常高的成功率是有可能的，但这需要更准确地了解心动过速环路以及技术发展，以实现对更大心房心肌区域的可控射频消融。射频消融房性期前收缩的经验比心房扑动更为有限，且发表的系列研究较少。总体而言，与旁道或结内折返相比，心房性心动过速的导管消融仍然是一个更困难且规范程度较低的操作。鉴于心房壁较薄，在这种情况下进行射频消融并非没有风险。我们认为，目前，射频导管消融治疗房性心律失常应仅保留给专门从事电生理检查和消融技术的中心。
