Keane D, Zhou L, Ruskin J
Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston 02114, USA.
Semin Interv Cardiol. 1997 Dec;2(4):251-65.
Catheter ablation for atrial fibrillation is based upon the critical mass of fibrillation hypothesis and aims to compartmentalize the atria by the creation of linear lesions, thereby reducing the amount of contiguous myocardium available for the propagation of multiple activation wavefronts. Early attempts at creating right atrial linear lesions with conventional catheter tip technology to treat patients with chronic and paroxysmal atrial fibrillation yielded disappointing results. Although more efficacious, the creation of extensive left atrial lesions has been associated with a high rate of thromboembolic stroke despite the administration of heparin and use of temperature feedback to control radiofrequency energy. Approaches to reduce the risk of stroke include: the creation of more continuous and effective right atrial lesions with linear array catheter technology and thereby reduce the requirement for left atrial ablation; the assessment of adjuvant pharmacological agents to inhibit platelet aggregation; guidance of radiofrequency energy delivery by intracardiac echo; assessment of transvenous cryotherapy as an alternative to radiofrequency energy in order to reduce endocardial disruption; and development of minimally invasive surgical approaches to left atrial epicardial ablation.
心房颤动的导管消融基于颤动临界质量假说，旨在通过制造线性损伤将心房分隔开，从而减少可供多个激活波前传播的连续心肌量。早期尝试使用传统导管尖端技术制造右心房线性损伤来治疗慢性和阵发性心房颤动患者，结果令人失望。尽管更有效，但制造广泛的左心房损伤与高血栓栓塞性中风发生率相关，尽管使用了肝素并利用温度反馈来控制射频能量。降低中风风险的方法包括：使用线性阵列导管技术制造更连续有效的右心房损伤，从而减少左心房消融的需求；评估抑制血小板聚集的辅助药物；通过心内超声引导射频能量传递；评估经静脉冷冻疗法作为射频能量的替代方法以减少心内膜破坏；以及开发用于左心房心外膜消融的微创外科手术方法。
