陈英伟,马长生

• 1:首都医科大学附属北京安贞医院心内科

摘要(Abstract)：

<正>自上世纪90年代末Haissaguerre等[1]率先采用导管消融术治疗心房颤动(房颤)以来,经过10多年的不断探索和经验积累,导管消融术已经成为房颤的重要治疗方式之一。基于近年来多项关于导管消融术治疗房颤循证医学证据,2014年美国心脏病学会(ACC)/美国心脏协会(AHA)/心律学会(HRS)房颤患者管理指南[2]进一步肯定了导管消融术在房颤治疗中的地位。该指南将反复发作、症状严重、药物

关键词(KeyWords)： 持续性心房颤动;导管消融

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 陈英伟,马长生

参考文献(References)：

• [1]Haissaguerre M,Jais P,Shah DC,et al.Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.N Engl J Med,1998,339:659-666.
• [2]January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.J Am Coll Cardiol,2014,64:e1-76.
• [3]Lim TW,Jassal IS,Ross DL,et al.Medium-term efficacy of segmental ostial pulmonary vein isolation for the treatment of permanent and persistent atrial fibrillation.Pacing Clin Electrophysiol,2006,29:374-379.
• [4]Kanagaratnam L,Tomassoni G,Schweikert R,et al.Empirical pulmonary vein isolation in patients with chronic atrial fibrillation using a three-dimensional nonfluoroscopic mapping system:longterm follow-up.Pacing Clin Electrophysiol,2001,24:1774-1779.
• [5]Pappone C,Oreto G,Rosanio S,et al.Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation:efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation.Circulation,2001,104:2539-2544.
• [6]Cheema A,Dong J,Dalal D,et al.Circumferential ablation with pulmonary vein isolation in permanent atrial fibrillation.Am J Cardiol,2007,99:1425-1428.
• [7]Elayi CS,Verma A,Di BL,et al.Ablation for longstanding permanent atrial fibrillation:results from a randomized study comparing three different strategies.Heart Rhythm,2008,5:1658-1664.
• [8]Oral H,Chugh A,Yoshida K,et al.A randomized assessment of the incremental role of ablation of complex fractionated atrial electrograms after antral pulmonary vein isolation for long-lasting persistent atrial fibrillation.J Am Coll Cardiol,2009,53:782-789.
• [9]Nademanee K,Mc Kenzie J,Kosar E,et al.A new approach for catheter ablation of atrial fibrillation:mapping of the electrophysiologic substrate.J Am Coll Cardiol,2004,43:2044-2053.
• [10]Oral H,Chugh A,Good E,et al.Randomized comparison of encircling and nonencircling left atrial ablation for chronic atrial fibrillation.Heart Rhythm,2005,2:1165-1172.
• [11]Oral H,Chugh A,Good E,et al.Radiofrequency catheter ablation of chronic atrial fibrillation guided by complex electrograms.Circulation,2007,115:2606-2612.
• [12]Estner HL,Hessling G,Ndrepepa G,et al.Acute effects and long-term outcome of pulmonary vein isolation in combination with electrogram-guided substrate ablation for persistent atrial fibrillation.Am J Cardiol,2008,101:332-337.
• [13]Li XP,Dong JZ,Liu XP,et al.Predictive value of early recurrence and delayed cure after catheter ablation for patients with chronic atrial fibrillation.Circ J,2008,72:1125-1129.
• [14]Porter M,Spear W,Akar JG,et al.Prospective study of atrial fibrillation termination during ablation guided by automated detection of fractionated electrograms.J Cardiovasc Electrophysiol,2008,19:613-620.
• [15]Brooks AG,Stiles MK,Laborderie J,et al.Outcomes of longstanding persistent atrial fibrillation ablation:a systematic review.Heart Rhythm,2010,7:835-846.
• [16]Arruda M,Mlcochova H,Prasad SK,et al.Electrical isolation of the superior vena cava:an adjunctive strategy to pulmonary vein antrum isolation improving the outcome of AF ablation.J Cardiovasc Electrophysiol,2007,18:1261-1266.
• [17]Inoue K,Kurotobi T,Kimura R,et al.Trigger-based mechanism of the persistence of atrial fibrillation and its impact on the efficacy of catheter ablation.Circ Arrhythm Electrophysiol,2012,5:295-301.
• [18]Roten L,Derval N,Jais P.Catheter ablation for persistent atrial fibrillation:elimination of triggers is not sufficient.Circ Arrhythm Electrophysiol,2012,5:1224-1232.
• [19]Zlochiver S,Yamazaki M,Kalifa J,et al.Rotor meandering contributes to irregularity in electrograms during atrial fibrillation.Heart Rhythm,2008,5:846-854.
• [20]Narayan SM,Krummen DE,Shivkumar K,et al.Treatment of atrial fibrillation by the ablation of localized sources:CONFIRM(Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation)trial.J Am Coll Cardiol,2012,60:628-636.
• [21]Haissaguerre M,Hocini M,Sanders P,et al.Catheter ablation of long-lasting persistent atrial fibrillation:clinical outcome and mechanisms of subsequent arrhythmias.J Cardiovasc Electrophysiol,2005,16:1138-1147.
• [22]Sacher F,Corcuff JB,Schraub P,et al.Chronic atrial fibrillation ablation impact on endocrine and mechanical cardiac functions.Eur Heart J,2008,29:1290-1295.
• [23]Takahashi Y,O'Neill MD,Hocini M,et al.Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation.J Am Coll Cardiol,2008,51:1003-1010.
• [24]Rostock T,Steven D,Hoffmann B,et al.Chronic atrial fibrillation is a biatrial arrhythmia:data from catheter ablation of chronic atrial fibrillation aiming arrhythmia termination using a sequential ablation approach.Circ Arrhythm Electrophysiol,2008,1:344-353.
• [25]O'Neill MD,Wright M,Knecht S,et al.Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint.Eur Heart J,2009,30:1105-1112.
• [26]Sang CH,Dong JZ,Liu XP,et al.A fixed approach for catheter ablation of chronic atrial fibrillation.Heart Rhythm,2010,7:S332.
• [27]Rostock T,Salukhe TV,Steven D,et al.Long-term single-and multiple-procedure outcome and predictors of success after catheter ablation for persistent atrial fibrillation.Heart Rhythm,2011,8:1391-1397.