心房颤动治疗的未来发展方向——混合消融  

Hybrid Ablation:a Future Development Trend in the Management of Atrial Fibrillation

作　　者：张宁[1] 侯明 梅波 金伟涛 谭雄[1] 杨明川 王亮[1] 刘勇 赖应龙[1] ZHANG Ning;HOU Ming;MEI Bo;JIN Weitao;TAN Xiong;YANG Mingchuan;WANG Liang;LIU Yong;LAI Yinglong(Department of Cardiovascular Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Department of Cardiovascular Surgery,Dazhou Central Hospital,Dazhou 635000,China)

机构地区：[1]川北医学院附属医院心脏大血管外科,四川省南充市637000 [2]四川省达州市中心医院心脏血管外科,635000

出　　处：《中国全科医学》2023年第9期1136-1145,共10页Chinese General Practice

基　　金：四川省科技厅应用基础研究项目(2021YJ0208);中华国际医学交流基金会心血管多学科整合思维研究基金(Z-2016-23-2001)。

摘　　要：心房颤动是临床常见的心律失常,已有研究证明其与严重不良心脑血管事件(心力衰竭、脑卒中和心肌梗死)有关,目前全球心房颤动的患病人数超过了3300万,预计未来40年内其患病率将增加1倍以上。多年来,医学相关人员在探究心房颤动的病理生理机制及开创改进其治疗方法等方面付出了大量努力。目前心房颤动的治疗管理仍是临床医学上的一个难题,尽管心房颤动治疗的手术消融和导管消融技术已逐渐趋于成熟,但对于心房颤动最佳的治疗方式、消融能量的选择尚无统一定论。导管消融通常需要多次手术且成功率低,而手术消融术后不良事件发生率较高。近年来,鉴于心脏外科医生和电生理学家之间的密切合作,结合导管及微创手术消融诞生了一种治疗心房颤动的新型策略——混合消融模式。混合消融克服了导管消融和微创手术消融的缺点,减少了不良结局,在治疗持续性心房颤动,尤其是长期持续性心房颤动上取得了可观的成效。本文主要通过回顾心房颤动消融的研究进展,对比分析目前混合消融模式治疗心房颤动的现有研究成果,归纳总结这种新型心房颤动治疗策略的优势与挑战,以期为临床心房颤动的治疗提供更多选择。As the most common type of arrhythmia,atrial fibrillation has proven to be associated with serious adverse cardiovascular and cerebrovascular events,such as heart failure,stroke and myocardial infarction.The global number of patients with atrial fibrillation has exceeded 33 million,and it is estimated to be more than doubled in the next 40 years.Although years of efforts have been made to the research on pathophysiological mechanism,and the exploration of new treatments and improvement of treatments regarding atrial fibrillation,the management of atrial fibrillation is still a difficult problem in clinical medicine,and there is no consensus on the best treatment and the choice of energy source for ablation in atrial fibrillation with the increasing advances made in surgical and catheter ablative techniques.Catheter ablation often requires multiple operations with unsatisfactory success rate and surgical ablation is often associated with high risk of postoperative adverse events.Hybrid ablation,a new treatment recently developed by the joint efforts of cardiac surgeons and electrophysiologists,integrates the merits of catheter ablation and minimally invasive surgical ablation but overcomes the limitations of the two,has proven to be effective in reducing the risk of postoperative adverse outcomes,and considerably efficacious in treating persistent atrial fibrillation,especially longterm persistent atrial fibrillation.We reviewed the advances in atrial fibrillation ablation,and comparatively analyzed existing studies of hybrid ablation,and summarized the advantages and challenges of this treatment,hoping to provide one more option for clinical treatment of atrial fibrillation.

关 键 词：心房颤动 心血管疾病 导管消融术 心内导管消融 外科手术消融 混合消融 综述 

分 类 号：R541.75[医药卫生—心血管疾病] R61[医药卫生—内科学]