脉冲场消融术治疗心房颤动:回顾与展望

Pavithran Guttipatti, N. Saadallah, Elaine Y. Wan
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摘要

脉冲场消融术(PFA)是一种治疗心房颤动(AF)的新型技术,它利用电场对电活性心脏组织进行非热不可逆电穿孔,诱导心脏细胞死亡。与传统的射频消融术(RFA)和冷冻消融术相比,PFA 只对心脏组织进行特异性消融,因此具有更高的安全性。不过,还有一些需要进一步优化的地方,包括与微泡形成相关的神经风险和消融术后的左心房功能。在人体试验中研究和测试了各种具有不同电脉冲波形的 PFA 设备,其中大多数使用微秒持续时间脉冲。更短的纳秒持续时间脉冲或纳秒 PFA 开始用于房颤消融的研究。在本综述中,我们将深入探讨目前用于 PFA 的波形、有待改进的领域、纳秒 PFA 背后的机制及其对心脏消融的临床影响。
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Pulsed Field Ablation for the Treatment of Atrial Fibrillation: A Review and a Look into its Future
Pulsed field ablation (PFA) is a novel technology to treat atrial fibrillation (AF) utilizing electric fields to induce nonthermal irreversible electroporation of electrically active cardiac tissue to induce cardiac cell death. PFA offers improved safety benefits compared to traditional radiofrequency ablation (RFA) and cryoablation by specifically ablating only cardiac tissue. However, there are avenues for further optimization including neurological risk associated with microbubble formation and left atrial function post ablation. Various PFA devices with different electric pulse waveforms have been studied and tested in human trials, with the majority utilizing microsecond duration pulses. Shorter nanosecond duration pulses, or nanosecond PFA, is beginning to be studied for AF ablation. In this review we will delve into current waveforms used for PFA, areas for improvement, mechanisms behind nanosecond PFA, and its clinical impact for cardiac ablation.
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