肺静脉隔离之外:治疗持续性心房颤动患者的方法。

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Expert Review of Cardiovascular Therapy Pub Date : 2024-09-01 Epub Date: 2024-09-12 DOI:10.1080/14779072.2024.2401876
Benjamin Buck, Mahmoud Houmsse
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引用次数: 0

摘要

导言:心房颤动(房颤)是最常见的心律失常,在美国的发病率约为 320 万例。导管消融是治疗阵发性房颤的一种成功的节律控制策略,但在持续性房颤患者中,无房颤生存率却大大降低。近年来,无数新型节律控制策略应运而生,每一种都有望提高持续性房颤消融的成功率:本综述讨论了针对持续性房颤的导管消融的多种新型技术和方法。作者通过搜索 PubMed 和 Google Scholar 数据库确定了相关论文,并考虑了所有确定的论文,无论其发表日期如何。文章首先讨论了电图分析的最新进展,这些进展提高了持续性房颤导管消融后的无房颤生存率。接下来,它讨论了几项试验,这些试验揭示了磁共振成像在指导持续性房颤消融方面的不足,以及它在结果预后方面仍然发挥的有限作用。最后,它讨论了一种新兴技术(马歇尔静脉消融术)和技术(人工智能辅助电图分析),这些技术和技术在改善持续性房颤消融方面已显示出前景:根据作者的专家意见,即将开展的持续性房颤消融术将采用循序渐进的方法:(1) 确保 PV 隔离;(2) 马歇尔静脉消融;(3) 人工智能辅助消融,以优化未来的持续性房颤消融结果。这种方法能系统地解决肺静脉以外的致心律失常源,而肺静脉是历来的治疗目标。
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Beyond pulmonary vein isolation: approaches to treat patients with persistent atrial fibrillation.

Introduction: Atrial fibrillation (AF) is the most common arrhythmia. Catheter ablation is a successful rhythm control strategy in paroxysmal AF, but it has demonstrated dramatically lower AF-free survival rates in patients with persistent AF. In recent years, myriad novel rhythm control strategies have been developed, each with the promise of improved persistent AF ablation success.

Areas covered: This review discusses multiple novel techniques and approaches to persistent AF. Authors identified relevant papers by searching PubMed and Google Scholar databases and considered all papers identified, regardless of publication date. It begins by discussing recent advances in electrogram analysis that yielded improved AF-free survival following persistent AF catheter ablation. Next, it discusses several trials revealing the shortcomings of MRI in guiding persistent AF ablation. Finally, it discusses one nascent technique (Vein of Marshall ablation) and technology (AI-assisted electrogram analysis) who have shown promise in improving persistent AF ablation.

Expert opinion: In the authors' expert opinions, upcoming persistent AF ablations will utilize a stepwise approach of (1) ensuring PV isolation, (2) Vein of Marshall ablation and (3) AI-assisted ablation to optimize future persistent AF ablation outcomes. This approach systematically addresses arrhythmogenic sources beyond the pulmonary veins, the historical treatment target.

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来源期刊
Expert Review of Cardiovascular Therapy
Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
0.00%
发文量
82
期刊介绍: Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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