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首页> 外文期刊>Circulation journal >Catheter Ablation for Atrial FibrillationWhat is the Necessary and AppropriateEndpoint of the Procedure?
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Catheter Ablation for Atrial FibrillationWhat is the Necessary and AppropriateEndpoint of the Procedure?

机译：房颤导管消融术的必要和适当终点是什么？

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Several different approaches have been proposed for targeting the pulmonary veins (PVs) or atria in catheter ablation for atrial fibrillation (AF). It was initially focal radiofrequency (RF) application inside the PV, then PV ostial isolation by segmental RF applications guided by a circular mapping catheter was developed (EP-guided method).1 Another standard method, circumferential PV isolation, was used to disconnect the ipsilateral PVs en bloc by linear RF applications all around the ipsilateral PVs (anatomical method)? In both the EP-guided and anatomical methods, the endpoint of the procedure is the electrical isolation of the 4 PVs from the left atrium, which subsequently revealed the limitations of these procedures. The application of RF at the PV ostia can cause PV ostial stenosis or obstruction, which sometimes requires additional angioplastic procedures. Ectopic firing from the myocardium around the PV isolation area often induces postoperative recurrence of AF. Furthermore, perpetuation of AF is induced by reentrant conduction between the PV and the surrounding atrial tissues (venous wave hypothesis). Today, the goal of either method is to isolate all the PVs, not at the ostium but outside the tubular portion (ie, PV antrum) to avoid the risk of venous stenosis and improve the procedural efficacy. That change in the endpoint resulted in an increased rate of cure for the paroxysmal form of AF, ranging from 85% to 95% after approximately 1.5 ablation procedures without anti-arrhythmic drugs (AADs)? The success rate for chronic AF is generally lower than that (70-85%).
机译：已经提出了几种针对导管消融的肺静脉（PVs）或心房靶向房颤（AF）的方法。最初是在PV内部进行聚焦射频（RF）应用，然后开发了通过圆形标测导管引导的分段RF应用对PV口腔进行隔离（EP引导方法）。1另一种标准方法，即周向PV隔离，用于断开PV通过在同侧PV周围的线性RF应用，将同侧PV整体封装（解剖方法）？在EP引导和解剖学方法中，手术的终点都是将4个PV与左心房电隔离，这随后揭示了这些手术的局限性。在PV口处应用RF会引起PV口狭窄或阻塞，有时需要进行额外的血管成形术。 PV隔离区周围心肌的异位激发通常会诱发AF的术后复发。此外，PV和周围心房组织之间的折返传导（AF假说）可诱发AF永存。如今，这两种方法的目的都是要分离所有的PV，而不是在口处，而是在管状部分（即PV窦腔）之外，以避免静脉狭窄的风险并提高手术效果。终点的这种改变导致阵发性房颤的治愈率提高，在不使用抗心律不齐药物（AAD）的情况下，经过约1.5次消融后，其治愈率从85％提高到95％？慢性房颤的成功率通常低于（70-85％）。

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