心房颤动导管消融术后房性心律失常复发的研究进展

doi:10.3969/j.issn.1006-5725.2024.10.002

实用医学杂志 ›› 2024, Vol. 40 ›› Issue (10): 1338-1343.doi: 10.3969/j.issn.1006-5725.2024.10.002

心房颤动导管消融术后房性心律失常复发的研究进展

念思琦,赵璐露,华宝桐()

昆明医科大学附属第一医院心内科（昆明 650032 ）

收稿日期:2023-11-15 出版日期:2024-05-25 发布日期:2024-05-21
通讯作者: 华宝桐 E-mail:newpalmtx@hotmail.com
作者简介:华宝桐，医学博士，教授。昆明医科大学第一附属医院心内科副主任医师，硕士研究生导师。国家卫健委心律失常器械植入培训导师、国家卫健委心律失常导管消融培训导师，房颤冷冻消融带教术者、Micra植入、左心耳封堵带教术者。中华医学会起搏和电生理分会全国青年委员；中国医师协会心律学分会全国青年委员；云南省起搏和电生理分会青委会副主任委员；中华医学会云南省心血管病分会心律失常学组副组长。长期致力于心律失常诊疗，擅长心脏起搏器植入及管理，以及复杂心律失常射频消融。在云南省内率先开展冷冻球囊房颤消融术、超高密度标测指导下复杂心律失常射频消融、三维标测系统指导下无射线心脏起搏器植入术等新技术。
基金资助:
国家自然科学基金项目(82160080);云南省临床医学研究中心子课题专项基金(202102AA310069);云南省“兴滇英才支持计划项目”(YNWR-MY-2020-011)

Research progress in atrial arrhythmia recurrence after catheter ablation for atrial fibrillation

Siqi NIAN,Lulu ZHAO,Baotong. HUA()

Department of Cardiology，the First Affiliated Hospital of Kunming Medical University，Kunming 650032，China

Received:2023-11-15 Online:2024-05-25 Published:2024-05-21
Contact: Baotong. HUA E-mail:newpalmtx@hotmail.com

摘要/Abstract

摘要：

心房颤动（atrial fibrillation， AF）是临床中最常见的心律失常之一，致死率及致残率较高。近年来，在导管消融等手术的帮助下，部分患者术后可维持窦性心律，达到根治房颤的效果。但目前首次射频消融手术后房性心律失常复发率仍在20% ~ 30%，房颤射频消融疗效尚未达到预期。探究消融术后复发的危险因素并进行干预，不断改良导管消融术式，这对降低复发风险极为重要。本文就心房颤动导管消融术后房性心律失常复发的最新研究进展作综述。

关键词: 心房颤动, 导管消融术, 心律失常复发, 肺静脉隔离

Abstract:

Atrial fibrillation （AF） is one of the most common arrhythmias in clinical practice， with a high rate of death and disability. In recent years， with the help of catheter ablation and other techniques， some patients can maintain sinus rhythm， achieving the goal of eradicating AF. However， the recurrence rate of atrial arrhythmias after the first radiofrequency ablation is still around 20% to 30% at present， and the efficacy of radiofrequency ablation for AF has not yet reached the expected level. Exploring the risk factors for recurrence after ablation， intervening and continuously and improving the catheter ablation procedure are extremely important for reducing the risk of recurrence. This article reviews the latest research progress on the recurrence of atrial arrhythmias after catheter ablation for AF.

Key words: atrial fibrillation, catheter ablation, arrhythmia recurrence, pulmonary vain isolation

中图分类号:

R541.7+5

念思琦,赵璐露,华宝桐. 心房颤动导管消融术后房性心律失常复发的研究进展[J]. 实用医学杂志, 2024, 40(10): 1338-1343.

Siqi NIAN,Lulu ZHAO,Baotong. HUA. Research progress in atrial arrhythmia recurrence after catheter ablation for atrial fibrillation[J]. The Journal of Practical Medicine, 2024, 40(10): 1338-1343.

参考文献 38

1	DU X， GUO L， XIA S， et al. Atrial fibrillation prevalence， awareness and managem-ent in a nationwide survey of adults in China ［J］. Heart， 2021， 107（7）：535-541. doi:10.1136/heartjnl-2020-317915 doi: 10.1136/heartjnl-2020-317915
2	HINDRICKS G， POTPARA T， DAGRES N， et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio- Thoracic Surgery （EACTS）： the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology （ESC） developed with the special contribution of the European Heart Rhythm Association （EHRA） of the ESC ［J］. Eur Heart J， 2021， 42（5）：373-498. doi:10.1093/eurheartj/ehaa798 doi: 10.1093/eurheartj/ehaa798
3	PACKER D L， MARK D B， ROBB R A， et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality， Stroke， Bleeding， and Cardiac Arrest Among Patients With Atrial Fibrillation： The CABANA Randomized Clinical Trial ［J］. JAMA， 2019， 321（13）：1261-1274.
4	中国医师协会心律学专业委员会，中华医学会心电生理和起搏分会，经冷冻球囊导管消融心房颤动中国专家共识［J］.中国心脏起搏与心电生理杂志， 2020，34（2）：95-108.
5	WAZNI O M， DANDAMUDI G， SOOD N . et al. Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation ［J］. N Engl J Med， 2021， 384（4）：316-324. doi:10.1056/nejmoa2029554 doi: 10.1056/nejmoa2029554
6	HONARBAKHSH S， MARTIN C A， MESQUITA J， et al. Atrial fibrillation cryoablation is an effective day case treatment： the UK PolarX vs. Arctic Front Advance experience ［J］. Europace， 2023， 25（11）：euad286. doi:10.1093/europace/euad286 doi: 10.1093/europace/euad286
7	MORAN D， DE R V， DE ASMUNDIS C， et al. Second generation cryoballoon ablation for atrial fibrillation in young adults： midterm outcome in patients under 40 years of age ［J］. Europace， 2018， 20（2）：295-300. doi:10.1093/europace/euw395 doi: 10.1093/europace/euw395
8	CHAHINE Y， AFROZE T， BIFULCO S F， et al.Cryoballoon temperature parameters during cryoballoon ablation predict pulmonary vein reconnection and atrial fibrillation recurrence ［J］. J Interv Card Electrophysiol， 2023， 66（6）：1367-1373. doi:10.1007/s10840-022-01429-0 doi: 10.1007/s10840-022-01429-0
9	TURAGAM M K， NEUZIL P， SCHMIDT B， et al. Safety and Effectiveness of Pulse Field Ablation to Treat Atrial Fibrillation： One-Year Outcomes From the MANIFEST-PF Registry ［J］. Circulation， 2023， 148（1）：35-46. doi:10.1161/circulationaha.123.064959 doi: 10.1161/circulationaha.123.064959
10	SCHMIDT B， BORDIGNONS， TOHOKU S， et al. 5S Study： Safe and Simple Single Shot Pulmonary Vein Isolation With Pulsed Field Ablation Using Sedation ［J］. Circ Arrhythm Electrophysiol， 2022， 15（6）：e010817. doi:10.1161/circep.121.010817 doi: 10.1161/circep.121.010817
11	KAWAMURA I， NEUZIL P， SHIVAMURTHY P， et al. How does the level of pulmonary venous isolation compare between pulsed field ablation and thermal energy ablation （radiofrequency， cryo， or laser）？［J］. Europace， 2021， 23（11）：1757-1766. doi:10.1093/europace/euab150 doi: 10.1093/europace/euab150
12	FU K， ZHU X， CHU H， et al. Re-recognize early recurrence of persistent atrial fibrillation ［J］. Front Cardiovasc Med， 2023， 10：1145695. doi:10.3389/fcvm.2023.1145695 doi: 10.3389/fcvm.2023.1145695
13	KIM Y G， BOO K Y， ChOI J I， et al. Early Recurrence Is Reliable Predictor of Late Recurrence After Radiofrequency Catheter Ablation of Atrial Fibrillation ［J］. JACC Clin Electrophysiol， 2021， 7（3）： 343-351. doi:10.1016/j.jacep.2020.09.029 doi: 10.1016/j.jacep.2020.09.029
14	FUJISAWA T， KAWAKAMI H， NAGAI T，et al. Premature atrial contraction immediately after catheter ablation was associated with late recurrence of atrial fibrillation［J］. Pacing Clin Electrophysiol， 2023， 46（2）：152-160. doi:10.1111/pace.14648 doi: 10.1111/pace.14648
15	LI G， WANG X， HAN J J， et al. Development and validation of a novel risk model for predicting atrial fibrillation recurrence risk among paroxysmal atrial fibrillation patients after the first catheter ablation ［J］. Front Cardiovasc Med， 2022， 9：1042573. doi:10.3389/fcvm.2022.1042573 doi: 10.3389/fcvm.2022.1042573
16	WINKLE R A， MEAD R H， ENGEL G， et al. Very long term outcomes of atrial fibrillation ablation ［J］. Heart Rhythm， 2023， 20（5）：680-688. doi:10.1016/j.hrthm.2023.02.002 doi: 10.1016/j.hrthm.2023.02.002
17	MUJOVIC N M， MARINKOVIC M M， MARKOVIC N， et al. Risk factors for late reconnections after circumferential pulmonary vein isolation guided by lesion size index-Data from repeat invasive electrophysiology procedure ［J］. Front Cardiovasc Med， 2023，9：986207. doi:10.3389/fcvm.2022.986207 doi: 10.3389/fcvm.2022.986207
18	VAN DER H C A J， WEBERNDORFER V， VROOMEN M， et al. Hybrid Ablation Versus Repeated Catheter Ablation in Persistent Atrial Fibrillation： A Randomized Controlled Trial ［J］. JACC Clin Electrophysiol， 2023， 9（7 Pt 2）：1013-1023. doi:10.1016/j.jacep.2022.12.011 doi: 10.1016/j.jacep.2022.12.011
19	VAN DER H C A J， WEBERNDORFER V， VROOMEN M， et al. Reply： Hybrid Ablation for Persistent Atrial Fibrillation： The Approach Matters ［J］. JACC Clin Electrophysiol， 2023， 9（7 Pt 2）：1195. doi:10.1016/j.jacep.2023.03.019 doi: 10.1016/j.jacep.2023.03.019
20	STEFANO B， ILARIA M， SHOTA T， et al. Efficacy and safety in patients treated with a novel radiofrequency balloon： a two centres experience from the AURORA collaboration ［J］. Europace， 2023， 25（5）：euad106. doi:10.1093/europace/euad106 doi: 10.1093/europace/euad106
21	DE G Y， SOFANOS D， TIJSKENS M， et al. The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection： Insights from the Middelheim-PVI Registry 2 ［J］. J Interv Card Electrophysiol， 2023，66（9）：2091-2101. doi:10.1007/s10840-023-01538-4 doi: 10.1007/s10840-023-01538-4
22	PARK C S， KIM H， LEE S R， et al. Prognostic implication of early recurrence after cryoballoon ablation in patients with atrial fibrillation ［J］. J Interv Card Electrophysiol， 2023，67（2）：285-292. doi:10.1007/s10840-023-01555-3 doi: 10.1007/s10840-023-01555-3
23	KUEFFER T， STEFANOVA A， MADAFFAIR A， et al. Pulmonary vein isolation durability and lesion regression in patients with recurrent arrhythmia after pulsed-field ablation ［J］. J Interv Card Electrophysiol， 2023，67（3）：503-511. doi:10.1007/s10840-023-01608-7 doi: 10.1007/s10840-023-01608-7
24	KISTLER P M， CHIENG D， SUGUMAR H， et al. Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation： The CAPLA Randomized Clinical Trial ［J］. JAMA， 2023， 329（2）：127-135. doi:10.1001/jama.2023.5285 doi: 10.1001/jama.2023.5285
25	CHIENG D， SUGUMAR H， HUNT A， et al. Impact of Posterior Left Atrial Voltage on Ablation Outcomes in Persistent Atrial Fibrillation： CAPLA Substudy ［J］. JACC Clin Electrophysiol， 2023， 9（11）：2291-2299. doi:10.1016/j.jacep.2023.08.002 doi: 10.1016/j.jacep.2023.08.002
26	BENALI K， BARRE V， HERMIDA A，et al.Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation： The PARTY-PVI Study ［J］. Circ Arrhythm Electrophysiol， 2023， 16（3）：e011354. doi:10.1161/circep.122.011354 doi: 10.1161/circep.122.011354
27	ISGANDAROVA K， BERGAU L， EL H M， et al. Impact of pulmonary vein anatomy and ostial dimensions on long-term outcome after single-shot device-guided cryoablation for paroxysmal atrial fibrillation ［J］. J Interv Card Electrophysiol， 2023， 66（9）：2125-2133. doi:10.1007/s10840-023-01554-4 doi: 10.1007/s10840-023-01554-4
28	SZEGEDI N， VECSEY-NAGY M， SIMON J， et al. Orientation of the right superior pulmonary vein affects outcome after pulmonary vein isolation ［J］. Eur Heart J Cardiovasc Imaging， 2022， 23（4）：515-523. doi:10.1093/ehjci/jeab041 doi: 10.1093/ehjci/jeab041
29	PONGRATZ J， RIESS L， HARTL S， et al. Left atrial appendage volume is an independent predictor of atrial arrhythmia recurrence following cryoballoon pulmonary vein isolation in persistent atrial fibrillation ［J］. Front. Cardiovasc， 2023， 10：1190860. doi:10.3389/fcvm.2023.1190860 doi: 10.3389/fcvm.2023.1190860
30	SIMON J， El MAHDIUI M， SMIT J M， et al. Left atrial appendage size is a marker of atrial fibrillation recurrence after radiofrequency catheter ablation in patients with persistent atrial fibrillation［J］. Clin Cardiol， 2022， 45（3）：273-281. doi:10.1002/clc.23748 doi: 10.1002/clc.23748
31	OSMANCIK P， HERMAN D， NEUZIL P， et al. 4-Year Outcomes After Left Atrial Appendage Closure Versus Nonwarfarin Oral Anticoagulation for Atrial Fibrillation ［J］. J Am Coll Cardiol， 2022， 79（1）：1-14. doi:10.1016/j.jacc.2021.10.023 doi: 10.1016/j.jacc.2021.10.023
32	KHAN H R， YAKUPOGLU H Y， KRALJ-HANS I， et al. Left Atrial Function Predicts Atrial Arrhythmia Recurrence Following Ablation of Long-Standing Persistent Atrial Fibrillation ［J］. Circ Cardiovasc Imaging， 2023， 16（6）：e015352. doi:10.1161/circimaging.123.015352 doi: 10.1161/circimaging.123.015352
33	NIELSEN A B， SKAARUP K G， DJERNAS K， et al. Left atrial contractile strain predicts recurrence of atrial tachyarrhythmia after catheter ablation ［J］. Int J Cardiol， 2022， 358：51-57. doi:10.1016/j.ijcard.2022.04.056 doi: 10.1016/j.ijcard.2022.04.056
34	LI Y， LI Y， SUN L， et al. Left atrial strain for predicting recurrence in patients with non-valvular atrial fibrillation after catheter ablation： a single-center two-dimensional speckle tracking retrospective study ［J］. BMC Cardiovasc Disord， 2022， 22（1）：468. doi:10.1186/s12872-022-02916-y doi: 10.1186/s12872-022-02916-y
35	KISHEVA A， YOTOV Y. Risk factors for recurrence of atrial fibrillation ［J］. Anatol J Cardiol， 2021， 25（5）： 338-345.
36	DONG X， MA C， FENG L， et al. Exploration of the Clinical Value and Significance of Body Mass Index， Mean Platelet Volume， and Left Atrial Structural Changes in Recurrence after Radiofrequency Ablation of Atrial Fibrillation ［J］. Altern Ther Health Med， 2023， 29（7）：160-165.
37	AHN H J， CHA M J， LEE E， et al. The higher recurrence rate after catheter ablation in younger patients with atrial fibrillation suggesting different pathophysiology ［J］. J Interv Card Electrophysiol， 2023， 66（7）：1609-1619. doi:10.1007/s10840-022-01461-0 doi: 10.1007/s10840-022-01461-0
38	ABU-QAOUD M R， KUMAR A， TARUN T， et al. Impact of SGLT2 Inhibitors on AtrialFibrillation Recurrence After Catheter Ablation in Patients WithType-2-Diabetes ［J］. JACC Clin Electrophysiol， 2023， 9（10）：2109-2118. doi:10.1016/j.jacep.2023.06.008 doi: 10.1016/j.jacep.2023.06.008

[1]	黄义梅,赵璐露,华宝桐. 植入式心电事件监测仪在房颤中的应用及进展[J]. 实用医学杂志, 2024, 40(21): 3095-3100.
[2]	张永旭,王岳松,杨达,董学滨,曹明勇,汪韶君,涂克祥. 左束支区域起搏对房室传导阻滞患者术后新发房性心律失常的影响[J]. 实用医学杂志, 2024, 40(13): 1846-1850.
[3]	罗乾友, 谢玲曾安宁, 王章兰杨钦宇潘竟刘军刘淑英 . 左心耳封堵术后封堵器周围残余漏的临床研究进展 [J]. 实用医学杂志, 2023, 39(6): 778-782.
[4]	王斌,胡丹,王芳芳. 血清尿酸及脑钠肽水平与射血分数保留心衰房颤患者房颤结构重构关系[J]. 实用医学杂志, 2023, 39(20): 2633-2637.
[5]	吴博,赖珩莉,沈国旺,陈震寰,刘源. 心脏淀粉样变性与心房颤动的关系及发病机制的研究进展[J]. 实用医学杂志, 2023, 39(17): 2277-2279.
[6]	王赛高静 . 富马酸二甲酯对过氧化氢诱导心脏微血管内皮细胞铁死亡的影响[J]. 实用医学杂志, 2023, 39(12): 1494-1499.
[7]	朱业, 刘佳, 谷慧阳, 陈佳杉, 顾翔, . 基因检测指导下非瓣膜性房颤患者华法林抗凝治疗的研究 [J]. 实用医学杂志, 2021, 37(18): 2355-2359.

心房颤动导管消融术后房性心律失常复发的研究进展

Research progress in atrial arrhythmia recurrence after catheter ablation for atrial fibrillation

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 38

相关文章 7

编辑推荐

Metrics

本文评价