洪晋,刘小慧

• 1:首都医科大学附属北京安贞医院心内科
• 2:北京市心肺血管疾病研究所

摘要(Abstract)：

<正>心房颤动(atrial fibrillation,AF,简称"房颤")是临床最常见的心律失常,目前患病率达1%～2%[1],可导致脑卒中、心力衰竭等并发症,严重影响患者生活质量,增加社会医疗经济负担[2]。经导管射频消融术(radiofrequency catheter ablation,RFCA)自1994年首次用于治疗房颤至今已衍生出多种手术方式[3],大规模临床试验证明其在转复并维持窦性心律、减少心脑血管事件、改善生活质量和减少卫生经济学成本等方面优于药物治疗[4]。最新的专家共识指出,一种或以上Ⅰ/Ⅲ类抗心律失常药物治疗无效以及患者不能耐受药

关键词(KeyWords)：

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 洪晋,刘小慧

参考文献(References)：

• [1]Camm AJ,Kirchhof P,Lip GY,et al.Guidelines for the management of atrial fibrillation:the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology(ESC).Eur Heart J,2010,31:2369-2429.
• [2]Lip GY,Tse HF,Lane DA.Atrial fibrillation.Lancet,2012,379:648-661.
• [3]刘兴鹏,董建增,马长生.心房颤动导管消融治疗的策略.中国介入心脏病学杂志,2004,12:247-249.
• [4]张澍.导管消融能否作为心房颤动的一线治疗方法?———国际大规模临床试验STOP-AF及CABANA研究解读.中国循环杂志,2011,26:404-406.
• [5]Calkins H,Kuck KH,Cappato R,et al.2012HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation:recommendations for patient selection,procedural techniques,patient management and follow-up,definitions,endpoints,and research trial design.J Interv Card Electrophysiol,2012,33:171-257.
• [6]Vazquez SR,Johnson SA,Rondina MT.Peri-procedural anticoagulation in patients undergoing ablation for atrial fibrillation.Thromb Res,2010,126:e69-e77.
• [7]董建增.心房颤动射频导管消融的围术期处理策略.心电学杂志,2008,27:37-40.
• [8]Garwood CL,Hwang JM,Moser LR.Striking a balance between the risks and benefits of anticoagulation bridge therapy in patients with atrial fibrillation:clinical updates and remaining controversies.Pharmacotherapy,2011,31:1208-1220.
• [9]Natale A,Raviele A,Arentz T,et al.Venice Chart international consensus document on atrial fibrillation ablation.J Cardiovasc Electrophysiol,2007,18:560-580.
• [10]Oral H,Chugh A,Ozaydin M,et al.Risk of thromboembolic events after percutaneous left atrial radiofrequency ablation of atrial fibrillation.Circulation,2006,114:759-765.
• [11]Wazni OM,Beheiry S,Fahmy T,et al.Atrial fibrillation ablation in patients with therapeutic international normalized ratio:comparison of strategies of anticoagulation management in the periprocedural period.Circulation,2007,116:2531-2534.
• [12]Page SP,Siddiqui MS,Finlay M,et al.Catheter ablation for atrial fibrillation on uninterrupted warfarin:can it be done without echo guidance?J Cardiovasc Electrophysiol,2011,22:265-270.
• [13]Hussein AA,Martin DO,Saliba W,et al.Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio:a safe and efficacious periprocedural anticoagulation strategy.Heart Rhythm,2009,6:1425-1429.
• [14]Cappato R,Calkins H,Chen SA,et al.Worldwide survey on the methods,efficacy,and safety of catheter ablation for human atrial fibrillation.Circulation,2005,111:1100-1105.
• [15]Schmidt M,Segerson NM,Marschang H,et al.Atrial fibrillation ablation in patients with therapeutic international normalized ratios.Pacing Clin Electrophysiol,2009,32:995-999.
• [16]Kwak JJ,Pak HN,Jang JK,et al.Safety and convenience of continuous warfarin strategy during the periprocedural period in patients who underwent catheter ablation of atrial fibrillation.J Cardiovasc Electrophysiol,2010,21:620-625.
• [17]Santangeli P,Di Biase L,Horton R,et al.Ablation of atrial fibrillation under therapeutic warfarin reduces periprocedural complications:evidence from a meta-analysis.Circ Arrhythm Electrophysiol,2012,5:302-311.
• [18]Di Biase L,Burkhardt JD,Mohanty P,et al.Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation:the impact of periprocedural therapeutic international normalized ratio.Circulation,2010,121:2550-2556.
• [19]Hayes CR,Keane D.Safety of atrial fibrillation ablation with novel multi-electrode array catheters on uninterrupted anticoagulation-a single-center experience.J Interv Card Electrophysiol,2010,27:117-122.
• [20]Saad EB,Costa IP,Costa RE,et al.Safety of ablation for atrial fibrillation with therapeutic INR:comparison with transition to low-molecular-weight heparin.Arq Bras Cardiol,2011,97:289-296.
• [21]Hakalahti A,Uusimaa P,Ylitalo K,et al.Catheter ablation of atrial fibrillation in patients with therapeutic oral anticoagulation treatment.Europace,2011,13:640-645.
• [22]Bunch TJ,Crandall BG,Weiss JP,et al.Warfarin is not needed in low-risk patients following atrial fibrillation ablation procedures.J Cardiovasc Electrophysiol,2009,20:988-993.
• [23]Lakkireddy D,Reddy YM,Di Biase L,et al.Feasibility and safety of dabigatran versus warfarin for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation:results from a multicenter prospective registry.J Am Coll Cardiol,2012,59:1168-1174.
• [24]Winkle RA,Mead RH,Engel G,et al.The use of dabigatran immediately after atrial fibrillation ablation.J Cardiovasc Electrophysiol,2012,23:264-268.
• [25]Scherr D,Sharma K,Dalal D,et al.Incidence and predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation.J Cardiovasc Electrophysiol,2009,20:1357-1363.
• [26]Prudente LA,Moorman JR,Lake D,et al.Femoral vascular complications following catheter ablation of atrial fibrillation.J Interv Card Electrophysiol,2009,26:59-64.