心房颤动消融的新视角——脉冲电场消融

张家明; 陈志坚

doi:10.13201/j.issn.1001-1439.2022.11.002

心房颤动消融的新视角——脉冲电场消融

张家明¹,
陈志坚^1, ,

- 华中科技大学同济医学院附属协和医院心内科(武汉，430022)

详细信息

通讯作者: 陈志坚，E-mail：chenzhijian9999@126.com

中图分类号: R541.7

收稿日期: 2022-10-06

刊出日期: 2022-11-13

Novel insight into ablation modality for the treatment of atrial fibrillation: pulsed field ablation

ZHANG Jiaming¹,
CHEN Zhijian^1, ,

- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

More Information

Corresponding author: CHEN Zhijian, E-mail: chenzhijian9999@126.com

Received Date: 06 October 2022

Publish Date: 13 November 2022

摘要

摘要: 心房颤动(房颤)的导管消融治疗是维持窦性心律的有效方法，但是目前以射频或冷冻为主要能源的消融技术疗效有待提高，术后可能出现肺静脉狭窄、膈神经和食管损伤等并发症。脉冲电场消融房颤通过非热能机制作用于细胞膜造成不可逆性电穿孔，选择性消融心肌组织，初步的临床研究显示其能有效实现肺静脉和左房后壁的电隔离，避免食管、膈神经和冠状动脉因附带损伤而出现并发症，具有良好的应用前景。
- 心房颤动 /
- 脉冲电场消融 /
- 电穿孔
Abstract: Catheter ablation is the mainstay therapy for the maintenance of sinus rhythm in patients with paroxysmal and persistent atrial fibrillation(AF). Radiorequency is the most frequent energy source implemented for AF ablation. The effectiveness of radiofrequency catheter ablation is still not satisfactory in maintaining rhythm control, and it is associated with several potential complications or significant adverse events including pulmonary vein stenosis, phrenic nerve palsy, or atrioesophageal fistulae. Pulsed field ablation(PFA) is a nonthermal ablation modality based on irreversible electroporation, which demonstrates a unique selectivity for myocardium, producing durable lesions while minimizing complications to surrounding structures at the same time. Preliminary clinical studies have shown that PFA is an attractive alternative to pulmonary vein isolation and additional left atrial posterior wall ablation, given the shorter procedure time, reduced risk of collateral injury, high acute pulmonary vein isolation rate and improved long-term durability. PFA hold great promise for the future of AF ablation but further research is needed for this novel technology to confirm the improved safety profile and potentially improved efficacy over existing ablation modalities for broad acceptance.
- atrial fibrillation /
- pulsed field ablation /
- electroporation

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图 1 脉冲电场消融的机制

Figure 1. Mechanism of pulsed field ablation

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图 2 热能和非热能消融方式隔离肺静脉

Figure 2. Thermal and nonthermal ablative modalities for pulmonary vein isolation

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