經導管非肺靜脈隔離術治療心房顫動

10.6666/ClinMed.202102_87(2).0016

宋偉廷；羅力瑋；陳適安

心房顫動（atrial fibrillation） ； 肺靜脈隔離術（pulmonary vein isolation） ； 基質（substrate）

臨床醫學月刊

87卷2期（2021 / 02 / 26）

107 - 113

繁體中文

對於心房顫動（atrial fibrillation, AF）的治療來說，肺靜脈隔離術（pulmonary vein isolation, PVI）的出現是很重要的發展。然而燒灼後長期的治療效果仍是差強人意，有時會需要接受多次的電燒，在非陣發性的心房顫動患者上尤其容易發生。此篇回顧統整了肺靜脈隔離術之外，其他燒灼方式的原則、目前的證據還有臨床結果。目前以肺靜脈隔離術作為陣發性心房顫動的最終治療已是共識，不過對於非陣發性心房顫動，許多學者仍然認為在肺靜脈以外的基質（substrate）改變是必要的。目前不建議經驗性的進行線性燒灼（linear ablation），因為很難完全達到線性阻斷，除非在術中出現心房撲動才會使用此法；大多機構採用複雜碎裂心房心電圖（complex fractionated atrial electrogram, CFAE）燒灼法，不過長期追蹤研究顯示效果有限；與單獨使用CFAE電燒相比，合併使用CFAE、非線性相似度（non-linear similarity）併相位地圖（phase mapping）去找出旋轉子（rotor）或者局部放電點，進行介質燒灼的效果較好。目前也建議用激發測試找出肺靜脈外的誘發點，以改善長期的燒灼成功率。

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