心房颤动治疗的未来发展方向——混合消融

doi:10.12114/j.issn.1007-9572.2022.0760

中国全科医学 ›› 2023, Vol. 26 ›› Issue (09): 1136-1145.DOI: 10.12114/j.issn.1007-9572.2022.0760

心房颤动治疗的未来发展方向——混合消融

张宁¹, 侯明¹, 梅波², 金伟涛¹, 谭雄¹, 杨明川¹, 王亮¹, 刘勇¹, 赖应龙¹^,^*()

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

收稿日期:2022-09-02 修回日期:2022-11-08 出版日期:2023-03-20 发布日期:2022-12-26
通讯作者: 赖应龙
作者贡献：张宁提出了研究选题方向，并撰写论文初稿；侯明、梅波负责文章框架的构思与设计；金伟涛、谭雄负责文献检索及资料的收集与整理；杨明川、王亮负责论文初稿的修订；刘勇、赖应龙负责文章的审阅及质量控制，对论文整体负责；所有作者确认了论文的最终稿。
基金资助:
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)

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

ZHANG Ning¹, HOU Ming¹, MEI Bo², JIN Weitao¹, TAN Xiong¹, YANG Mingchuan¹, WANG Liang¹, LIU Yong¹, LAI Yinglong¹^,^*()

1. Department of Cardiovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
2. Department of Cardiovascular Surgery, Dazhou Central Hospital, Dazhou 635000, China

Received:2022-09-02 Revised:2022-11-08 Published:2023-03-20 Online:2022-12-26
Contact: LAI Yinglong

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摘要/Abstract

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3 300万，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。

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

Abstract:

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 long-term 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.

Key words: Atrial fibrillation, Cardiovascular disease, Catheter ablation, Endocardial catheter ablation, Surgical ablation, Hybrid ablation, Review

张宁,侯明,梅波,等. 心房颤动治疗的未来发展方向——混合消融[J]. 中国全科医学, 2023, 26(09): 1136-1145. DOI: 10.12114/j.issn.1007-9572.2022.0760.
ZHANG Ning,HOU Ming,MEI Bo, et al. Hybrid Ablation: a Future Development Trend in the Management of Atrial Fibrillation[J]. Chinese General Practice, 2023, 26(09): 1136-1145. DOI: 10.12114/j.issn.1007-9572.2022.0760.

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类型	定义
阵发性心房颤动	在发病7 d内自动终止或干预终止
持续性心房颤动	持续时间超过7 d，包括>7 d后通过复律（药物或电）终止发作
长程持续性心房颤动	当决定采用节律控制策略时，心房颤动持续时间超过12个月
永久性心房颤动	医生和患者共同决定放弃恢复或维持窦性心律，反映患者和医生对心房颤动的治疗态度，并不是心房颤动自身病理生理特征

类型	定义
阵发性心房颤动	在发病7 d内自动终止或干预终止
持续性心房颤动	持续时间超过7 d，包括>7 d后通过复律（药物或电）终止发作
长程持续性心房颤动	当决定采用节律控制策略时，心房颤动持续时间超过12个月
永久性心房颤动	医生和患者共同决定放弃恢复或维持窦性心律，反映患者和医生对心房颤动的治疗态度，并不是心房颤动自身病理生理特征

绝对禁忌证	相对禁忌证
左心耳血栓	心功能>Ⅱ级（NYHA分级）	胸部严重创伤
妊娠	慢性肾功能不全≥3期	左心房内径>70 mm
Barrett食管炎史	左心室射血分数<30%	体质指数>45 kg/m²
活动性感染或脓毒症	重度肺动脉高压	晚期肝病
合并其他心脏大血管手术	右心室流出道梗阻	结缔组织疾病
抗凝禁忌	心包炎、心包粘连	胸（纵隔肿瘤）放化疗
不稳定的冠状动脉疾病	重度慢性阻塞性肺疾病
3个月内有出血卒中史	急性失代偿性心力衰竭

绝对禁忌证	相对禁忌证
左心耳血栓	心功能>Ⅱ级（NYHA分级）	胸部严重创伤
妊娠	慢性肾功能不全≥3期	左心房内径>70 mm
Barrett食管炎史	左心室射血分数<30%	体质指数>45 kg/m²
活动性感染或脓毒症	重度肺动脉高压	晚期肝病
合并其他心脏大血管手术	右心室流出道梗阻	结缔组织疾病
抗凝禁忌	心包炎、心包粘连	胸（纵隔肿瘤）放化疗
不稳定的冠状动脉疾病	重度慢性阻塞性肺疾病
3个月内有出血卒中史	急性失代偿性心力衰竭

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

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