Guiraudon G M, Klein G J, Yee R, Guiraudon C M
University Hospital, London, Ontario, Canada.
Arch Mal Coeur Vaiss. 1996 Feb;89 Spec No 1:123-7.
1995 is the fifth anniversary of the advent of catheter ablation for the treatment of supraventricular tachycardia. Surgery has established the principles of the interventional approaches: 1) identification of the mechanism; 2) localization of the site of the mechanism; 3) identification of the anatomical arrhythmogenic substrate and its localization using preoperative and intraoperative electrophysiological cardiac mapping; 4) ablation of the arrhythmogenic substrate using "surgical" dissection or excision or various forms of energy to neutralize the substrate: cryoablation, laser, etc. Surgical approaches also established the EP interventions as the first line of therapy because they are curative. Currently, surgery for supraventricular tachycardia is essentially confined to atrial fibrillation, and after attempted catheter ablation for the Wolff-Parkinson-White syndrome. Atrial fibrillation is a complex arrhythmia, commonly associated with structural heart disease. To understand atrial fibrillation, a number of premises should be reviewed: atrial functional anatomy, atrial pathology, atrial fibrillation mechanism (s) and clinical presentation. The role of atrial fibrillation in terms of symptoms, morbidity and mortality is not clear because it is difficult to determine if atrial fibrillation is a symptom, a marker, an autonomous disease albeit it is in most cases an aggravating factor. Surgical rationales for atrial fibrillation are based on three concepts: exclusion, fragmentation and channelling. The Corridor operation was the first used direct surgical approach. The Maze operation and other techniques (fragmentation, spiral) have been reported. All surgical techniques have been reported with good results in terms of sinus node function and exercise tolerance, and to various degrees, in terms of atrial contraction. Currently, there is a trend to combine direct atrial fibrillation surgery with surgery for mitral valve albeit beneficial effects are not documented.
1995年是导管消融术用于治疗室上性心动过速问世的五周年。外科手术确立了介入治疗方法的原则：1）确定机制；2）确定机制所在部位；3）利用术前和术中的心内电生理标测确定解剖性致心律失常基质及其定位；4）使用“外科”剥离或切除或各种能量形式来消除基质，从而消融致心律失常基质：冷冻消融、激光等。外科手术方法还将电生理干预确立为一线治疗方法，因为它们具有治愈性。目前，室上性心动过速的外科手术主要限于心房颤动，以及在尝试对预激综合征进行导管消融之后。心房颤动是一种复杂的心律失常，通常与结构性心脏病有关。为了理解心房颤动，应回顾一些前提条件：心房功能解剖学、心房病理学、心房颤动机制和临床表现。心房颤动在症状、发病率和死亡率方面的作用尚不清楚，因为很难确定心房颤动是一种症状、一个标志物、一种自主性疾病，尽管在大多数情况下它是一个加重因素。心房颤动的外科手术理论基础基于三个概念：排除、分割和通道化。“走廊”手术是最早使用的直接外科手术方法。已经报道了“迷宫”手术和其他技术（分割、螺旋形）。就窦房结功能和运动耐量而言，所有外科技术均已报道取得了良好效果，而就心房收缩而言，也取得了不同程度的良好效果。目前，有一种将直接心房颤动手术与二尖瓣手术相结合的趋势，尽管尚未证实其有益效果。
