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題名 | Atrial Fibrillation: New Horizons=心房顫動:新的視域 |
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作者 | 郭啟泰; 林圀宏; 李英雄; | 書刊名 | 長庚醫學 |
卷期 | 26:10 2003.10[民92.10] |
頁次 | 頁712-721 |
分類號 | 415.31 |
關鍵詞 | 心房顫動; 心房重塑; 高頻電燒治療; 肺靜脈; Atrial fibrillation; Atrial remodeling; Radiofrequency ablation; Pulmonary vein; |
語文 | 英文(English) |
中文摘要 | 心房顫動是要床上最常見的心律不整。近年來對於心房顫動致病機轉的了解已有重大的改變,以往所認為的多重迴路模型機轉,已受近年來觀察提出的單一病源或單一迴路的模型機轉所桃戰。心房電位的異常是造成心房顫動的誘因,而膜離子電位則為其中關鍵。而angiotensin conveting enzyme inhibior(ACEI)轉化脢抑制劑在回復心房電位及結構變化所扮演的角色也引起大家的興趣。 將心房顫動恢復成正常竇性心律似乎是回復「心房重塑」atrial remodeling最好的方式。抗心律不整藥物的效果不盡理想,而其中amiodarone似乎是曘有效的,其他的藥物如verapamil及轉化脢抑制劑(ACEI)對於回復心房的變化可能也有幫助。 也可以使用非藥物的方式控制心房顫動的心跳速度或者恢復成正常竇性心律。最近,以局部電燒的方式治療引起高度的興趣。肺靜脈是導致心房顫動常見的來源,因此在肺靜脈找出心內膜最早的活化點進行電燒治療已得到不等程度的成功。另外一種電燒方式是利用特別的環狀超音波系統以及冷凝電燒鄉,在肺靜脈的開口環狀電燒。最近研究的結果比較傾向支持前者局部電燒,因為回繞肺靜脈的心肌纖非連續的,我們可以利用電生理導管辨識心肌纖維高頻去極化的訊號,判斷心肌組織的分佈,再做片狀的電燒治療。 |
英文摘要 | Atrial fibrillation (AF) is the most common cardiac arrhythmia seen in clinical practice. The understanding of the pathopysiology of AF has changed drastically during the last several decades. Recent observations have challenged the concept of the ultiple circuit reentry model in favor of single focus or single circuit reentry models. Artial electrical dysfunction provides a favorable substrate and transmenbrane ionic currents are key determinants. Interest has also been generated in the role of angiotensin conveting enzyme (ACE) inhibition in reversing the electrical and structural remodeling. Reverting to the sinus rhythm seems to be the best way for reverse remodeling of atria during atrial fibrillation. Antiarrhythmic drugs (ADDs) are only modestly effective. Of these amiodarone seems to provide the most benefits. Drugs like verapamil and ACE inhibitors may also help as adjusvant therapies in the reverse remodeling of artia. Nonpharmacolgical methods have been used to control both rate and rhythm for patients with AF. Recently, there has been a surge in interest to focal ablation of artial foci. Focal sources of AF are commonly found in pulmonary veins (PV). Ablation in pulmonary veins through identification of the earliest endocardial activation has met with variable success. Anatomical approaches have involved circumferential radiofrequency abolation of pulmonary vein ostia using novel techniques such as balloon based circumferential ultrasound ablation system and circular cryoablation catheter. Most recently the segmental approach is preferred because the myocardial fibers surrounding the PV are not continuous. Segments where musculature is present can be identified using high frequency depolarization signals recorded through multi-electrode loop catheter or even conventional catheters. |
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