山东大学学报 (医学版) ›› 2025, Vol. 63 ›› Issue (11): 105-116.doi: 10.6040/j.issn.1671-7554.0.2024.1218
• 综述 • 上一篇
张炎1,2*,杨馨妍1,2*,林明杰1,2,张凯1,荣冰1,陈桐帅1,徐兴晟1,2,孙慧1,2,韩文强1,蓝庆肃1,刘欣磊1,王君涛1,2,钟敬泉1,2
ZHANG Yan1,2*, YANG Xinyan1,2*, LIN Mingjie1,2, ZHANG Kai1, RONG Bing1, CHEN Tongshuai1, XU Xingsheng1,2, SUN Hui1,2, HAN Wenqiang1, LAN Qingsu1, LIU Xinlei1, WANG Juntao1,2, ZHONG Jingquan1,2
摘要： 导管消融已经成为心房颤动(房颤)的一线治疗方式,对比抗心律失常药物,导管消融在降低房颤复发率和心血管住院率、延缓房颤进展、改善生活质量等方面有显著的优势。传统消融能量包括冷冻球囊消融(冷)和射频消融(热),目前冷冻球囊已发展至第四代,射频消融在压力感应技术和多孔灌注技术基础上,发展出了超高功率短时程消融模式(very high-power short-duration,vHPSD),这些技术革新进一步提高了导管消融手术的效率和安全性。新兴消融能量包括激光球囊消融(光)和脉冲场消融(电),新能量在房颤治疗尤其是肺静脉隔离(pulmonary vein isolation, PVI)上取得了良好的效果。近年来,脉冲场消融(pulsed field ablation,PFA)以其高效性和可靠的安全性成为导管消融领域最受关注的热点技术,利用电穿孔效应,在控制电场强度的情况下,PFA可以选择性地损伤心肌细胞,避免对膈神经、食管等周围组织的损伤。本文总结了这四种能量消融技术的最新临床进展,对四种能量在房颤消融中的安全性和有效性进行了比较分析。结果显示,四种不同能量均适用于PVI,PFA技术显著缩短了手术时间和术者学习曲线,降低了膈神经损伤、食管损伤等传统并发症发生率,但新能量的长期有效性、安全性以及在肺静脉外结构中的应用需要更长时间、更大规模的临床研究来确认。
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