{"title":"提高房颤患者肺静脉隔离安全性和有效性的方法和技术","authors":"Krasimir R. Dzhinsov","doi":"10.3897/folmed.65.e103031","DOIUrl":null,"url":null,"abstract":"The most common type of sustained arrhythmia is atrial fibrillation (AF). Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation, which has emerged as the primary therapeutic strategy for atrial fibrillation patients. Unfortunately, about one-third of patients experience recurrent atrial arrhythmias after the procedure. The leading cause of AF recurrence after PVI, especially during the first year, is reconnection of the pulmonary veins. There are different techniques and methods that could increase the efficacy of the procedure by making durable pulmonary vein isolation. A literature search was conducted using the terms atrial fibrillation, ablation, pulmonary vein isolation, and durable PVI in the PubMed, Scopus, and Web of Science databases. Durable pulmonary vein isolation could be achieved by avoiding gaps in the ablation line and PV reconnections using pharmacological testing, waiting time, various indexes based on data from the electroanatomical mapping system, and special ablation catheters. Furthermore, detecting the gaps in the ablation line in the end of the procedure using different pacing and mapping techniques and application of additional energy to close those gaps could increase the success rate of the procedure. Most commonly, AF recurrence after PVI is due to PV reconnections caused by gaps in the ablation line. To achieve safer and more effective PVI, the procedure has to be standardized and operator-independent with reproducible success rate and safety profile.","PeriodicalId":12415,"journal":{"name":"Folia medica","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Methods and techniques for increasing the safety and efficacy of pulmonary vein isolation in patients with atrial fibrillation\",\"authors\":\"Krasimir R. Dzhinsov\",\"doi\":\"10.3897/folmed.65.e103031\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"The most common type of sustained arrhythmia is atrial fibrillation (AF). Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation, which has emerged as the primary therapeutic strategy for atrial fibrillation patients. Unfortunately, about one-third of patients experience recurrent atrial arrhythmias after the procedure. The leading cause of AF recurrence after PVI, especially during the first year, is reconnection of the pulmonary veins. There are different techniques and methods that could increase the efficacy of the procedure by making durable pulmonary vein isolation. A literature search was conducted using the terms atrial fibrillation, ablation, pulmonary vein isolation, and durable PVI in the PubMed, Scopus, and Web of Science databases. Durable pulmonary vein isolation could be achieved by avoiding gaps in the ablation line and PV reconnections using pharmacological testing, waiting time, various indexes based on data from the electroanatomical mapping system, and special ablation catheters. Furthermore, detecting the gaps in the ablation line in the end of the procedure using different pacing and mapping techniques and application of additional energy to close those gaps could increase the success rate of the procedure. Most commonly, AF recurrence after PVI is due to PV reconnections caused by gaps in the ablation line. To achieve safer and more effective PVI, the procedure has to be standardized and operator-independent with reproducible success rate and safety profile.\",\"PeriodicalId\":12415,\"journal\":{\"name\":\"Folia medica\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-10-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Folia medica\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3897/folmed.65.e103031\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Dentistry\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Folia medica","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3897/folmed.65.e103031","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Dentistry","Score":null,"Total":0}
引用次数: 0
摘要
最常见的持续性心律失常类型是心房颤动(AF)。肺静脉隔离(PVI)是房颤导管消融治疗的基础,已成为房颤患者的主要治疗策略。不幸的是,大约三分之一的患者在手术后会复发性心房心律失常。PVI后,尤其是第一年,房颤复发的主要原因是肺静脉的重新连接。有不同的技术和方法可以通过持久的肺静脉隔离来提高手术的疗效。在PubMed、Scopus和Web of Science数据库中使用房颤、消融、肺静脉隔离和持久PVI等术语进行文献检索。通过药理学测试、等待时间、基于电解剖制图系统数据的各种指标以及特殊的消融导管,可以避免消融线间隙和PV重新连接,从而实现持久的肺静脉隔离。此外,在手术结束时使用不同的起搏和定位技术来检测消融线中的间隙,并应用额外的能量来关闭这些间隙,可以提高手术的成功率。最常见的是,PVI后房颤复发是由于消融线间隙引起的PV重新连接。为了实现更安全、更有效的PVI,该程序必须标准化,并且与操作人员无关,具有可重复的成功率和安全性。
Methods and techniques for increasing the safety and efficacy of pulmonary vein isolation in patients with atrial fibrillation
The most common type of sustained arrhythmia is atrial fibrillation (AF). Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation, which has emerged as the primary therapeutic strategy for atrial fibrillation patients. Unfortunately, about one-third of patients experience recurrent atrial arrhythmias after the procedure. The leading cause of AF recurrence after PVI, especially during the first year, is reconnection of the pulmonary veins. There are different techniques and methods that could increase the efficacy of the procedure by making durable pulmonary vein isolation. A literature search was conducted using the terms atrial fibrillation, ablation, pulmonary vein isolation, and durable PVI in the PubMed, Scopus, and Web of Science databases. Durable pulmonary vein isolation could be achieved by avoiding gaps in the ablation line and PV reconnections using pharmacological testing, waiting time, various indexes based on data from the electroanatomical mapping system, and special ablation catheters. Furthermore, detecting the gaps in the ablation line in the end of the procedure using different pacing and mapping techniques and application of additional energy to close those gaps could increase the success rate of the procedure. Most commonly, AF recurrence after PVI is due to PV reconnections caused by gaps in the ablation line. To achieve safer and more effective PVI, the procedure has to be standardized and operator-independent with reproducible success rate and safety profile.