■心房颤动(AF)的治疗有了很大的发展,肺静脉隔离术(PVI)成为一种既定的治疗方法。然而,持续性房颤导管消融术后的结局仍不令人满意.混合导管手术消融已成为持续性房颤的治疗方法。结合两种干预措施的优势。本叙述性综述的目的是全面检查有关房颤混合消融术的知识现状。
■使用术语“混合消融”进行彻底的PubMed搜索,\"心房颤动\",“导管消融”,在1980年至2024年的时间框架内,“心脏病学指南”共发表了138,969篇文章。通过一系列有组织的会议和讨论,就选定的条款达成了共识。
■PVI表现出更高的窦性心律维持率,尤其是阵发性房颤。然而,对于持续性房颤,疗效并不高。其他消融策略,例如线性消融,复杂分割心房电描记图消融,低压区消融以及后壁隔离,缺乏一致的有效性证据。混合消融,涉及心脏外科医生和电生理学家之间的合作,为难以治疗的房颤提供了一个有希望的替代方案。最近的研究报告了混合消融的良好结果,无房性心律失常的发生率从53.5%到76%,超越那些单独的导管消融,这可能是由于在混合消融术期间对非肺静脉病灶和左心耳切除或闭合进行了更好的病变耐久性或干预。与混合消融相关的并发症发生率高于单独的导管消融。
■虽然已经报道了混合消融治疗持续性房颤的良好结果,与导管消融术相比,由于其侵入性,因此不推荐用于所有房颤患者.此外,部分持续性房颤患者单用导管消融术维持窦性心律.需要更多的临床数据来确定哪些患者是混合消融的合适候选者。
UNASSIGNED: Treatment for atrial fibrillation (AF) has evolved significantly, with pulmonary vein isolation (PVI) becoming an established treatment. However, the outcomes following catheter ablation for persistent AF remain unsatisfactory. Hybrid catheter-surgical ablation has emerged as a therapeutic approach for persistent AF, combining the strengths of both interventions. The purpose of this narrative review is to comprehensively examine the current state of knowledge regarding hybrid ablation for AF.
UNASSIGNED: A thorough PubMed search using the terms \"hybrid ablation\", \"atrial fibrillation\", \"catheter ablation\", and \"guideline on cardiology\" within the timeframe of 1980 to 2024 resulted in 138,969 articles. Consensus on the selected articles was reached through a series of structured meetings and discussions.
UNASSIGNED: PVI has demonstrated higher sinus rhythm maintenance rates, especially for paroxysmal AF. However, the efficacy is not as high for persistent AF. Additional ablation strategies, such as linear ablation, complex fractionated atrial electrogram ablation, low voltage zone ablation as well as posterior wall isolation, lack consistent evidence of effectiveness. Hybrid ablation, involving collaboration between cardiac surgeons and electrophysiologists, presents a promising alternative for hard-to-treat AF. Recent studies report favorable outcomes of hybrid ablation, with atrial arrhythmia-free rates ranging from 53.5% to 76%, surpassing those of catheter ablation alone, which might result from better lesion durability or intervention for non-PV foci and left atrial appendage excision or closure during hybrid ablation. The rate of complications associated with hybrid ablation is higher than catheter ablation alone.
UNASSIGNED: While favorable outcomes of hybrid ablation for persistent AF have been reported, it is not recommended for all AF patients due to its invasiveness compared to catheter ablation. Additionally, some patients with persistent AF maintain sinus rhythm with catheter ablation alone. More clinical data are needed to determine which patients are suitable candidates for hybrid ablation.