单纯碎裂电位指导房颤消融的初步临床观察
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摘要
【目的】探讨碎裂电位指导心房颤动(房颤)导管射频消融的可行性。
【方法】22例药物治疗无效有症状性房颤患者(阵发性16例,持续性6例),在自发或诱发的房颤时,用CARTO构建左房或左右心房的三维模型并标测、消融碎裂电位,终点是消除标测到所有碎裂电位或转复窦性心律。
【结果】碎裂电位消融后,13例(59%)转复为窦律(直接转复7例,先转为房速/房扑然后转复6例),9例消融未转复窦律者行电复律或药物复律成功。6例复发(5例房速/房扑,1例阵发性房颤)再次消融,5例成功,平均随访10.9±4.8(3～18)月,共有16例(73%)无快速房性心律失常事件,碎裂电位主要分布于左侧房间隔、肺静脉周围、左心房顶部。碎裂电位消融后房颤终止前房颤周期与碎裂电位消融前相比明显延长(157±18ms vs 211±32ms,P<0.05)。除一例发生心脏压塞并心包穿刺成功引流外,无手术相关的并发症和后遗症。
【结论】碎裂电位指导房颤导管射频消融安全有效可行。
【Objective】To evaluate the feasibility of radiofrequency catheter ablation of atrial fibrillation (AF) guided by complex fractionated atrial electrograms(CFAEs).
【Methods】Twenty-two patients with drug refractory and symptomatic AF (16 paroxysmal, 6 persisten) were enrolled. Using CARTO, the left atrial or biatrial replica was created during spontaneous or induced AF, and areas associated with CFAEs were identified. Radiofrequency ablation of the areas with CFAEs was performed and the end points were to eliminate all mapped CFAEs or convert to sinus rhythm.
【Results】AF converted to sinus rhythm in 13 patients (59%), directly to sinus rhythm in 7 or via the ablation of intermediate atrial tachycardia(AT) or atrial flutter (AFL) in 6 patients. The remaining nine patients required cardioversion with D.C. shock or drug. Repeat ablation was performed in 6 patients(5 AT/AFL, 1 paroxysmal AF). During a mean of 10.9±4.8 months follow-up, 16 patients(73%) were free of arrhythmia and symptoms. CFAEs were most commonly found along the left interatrial septum, pulmonary veins, roof of left atrium. CFAEs ablation prolonged atrial fibrillation cycle length (AFCL) (157±18ms vs 211±32ms,P<0.05). One patient had pericardial tamponade that required pericardiocentesis without any sequelae.
【Conclusion】Radiofrequency catheter ablation of atrial fibrillation (AF) guided by CFAEs is safe and effective.
【方法】22例药物治疗无效有症状性房颤患者(阵发性16例,持续性6例),在自发或诱发的房颤时,用CARTO构建左房或左右心房的三维模型并标测、消融碎裂电位,终点是消除标测到所有碎裂电位或转复窦性心律。
【结果】碎裂电位消融后,13例(59%)转复为窦律(直接转复7例,先转为房速/房扑然后转复6例),9例消融未转复窦律者行电复律或药物复律成功。6例复发(5例房速/房扑,1例阵发性房颤)再次消融,5例成功,平均随访10.9±4.8(3～18)月,共有16例(73%)无快速房性心律失常事件,碎裂电位主要分布于左侧房间隔、肺静脉周围、左心房顶部。碎裂电位消融后房颤终止前房颤周期与碎裂电位消融前相比明显延长(157±18ms vs 211±32ms,P<0.05)。除一例发生心脏压塞并心包穿刺成功引流外,无手术相关的并发症和后遗症。
【结论】碎裂电位指导房颤导管射频消融安全有效可行。
【Objective】To evaluate the feasibility of radiofrequency catheter ablation of atrial fibrillation (AF) guided by complex fractionated atrial electrograms(CFAEs).
【Methods】Twenty-two patients with drug refractory and symptomatic AF (16 paroxysmal, 6 persisten) were enrolled. Using CARTO, the left atrial or biatrial replica was created during spontaneous or induced AF, and areas associated with CFAEs were identified. Radiofrequency ablation of the areas with CFAEs was performed and the end points were to eliminate all mapped CFAEs or convert to sinus rhythm.
【Results】AF converted to sinus rhythm in 13 patients (59%), directly to sinus rhythm in 7 or via the ablation of intermediate atrial tachycardia(AT) or atrial flutter (AFL) in 6 patients. The remaining nine patients required cardioversion with D.C. shock or drug. Repeat ablation was performed in 6 patients(5 AT/AFL, 1 paroxysmal AF). During a mean of 10.9±4.8 months follow-up, 16 patients(73%) were free of arrhythmia and symptoms. CFAEs were most commonly found along the left interatrial septum, pulmonary veins, roof of left atrium. CFAEs ablation prolonged atrial fibrillation cycle length (AFCL) (157±18ms vs 211±32ms,P<0.05). One patient had pericardial tamponade that required pericardiocentesis without any sequelae.
【Conclusion】Radiofrequency catheter ablation of atrial fibrillation (AF) guided by CFAEs is safe and effective.
引文
[1] Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998, 339: 659-666
[2] Arentz T, Jander N, von Rosenthal J, et al. Incidence of pulmonary vein stenosis 2 years after radiofrequency catheter ablation of refractory atrial fibrillation. Eur Heart J,2003,24 : 963-969
[3] Oral H, Knight BP, Ozaydin M, et al. Segmental ostial ablation to isolate the pulmonary veins during atrial fibrillation: feasibility and mechanistic insights.Circulation,2002,106:1256-1262
[4] Haissaguerre M, Jais P ,Shah DC, et al. Catheter ablation of chronic atrial fibrillation targeting the reinitiating triggers. J Cardiovasc Electrophysiol, 2000, 11: 2-10
[5] Oral H, Knight BP, Tada H, et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation, 2002, 105:1077-1081
[6] Pappone C, Rosanio S, Oreto G,et al. Circumferential radiofrequency ablation of pulmonary vein ostia: A New Anatomic Approach for Curing Atrial Fibrillation. Circulation,2000,102:2619-2628
[7] Arentz T, von Rosenthal J, Blum T,et al. Feasibility and safety of pulmonary vein isolation using a new mapping and navigation system in patients with refractory atria fibrillation. Circulation, 2003,108:2484-2490
[8] Hocini M, Jais P, Sanders P, et al. Techniques, evaluation, and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation: a prospective randomized study. Circulation,2005,112:3688 -3696
[9] Jais P, Hocini M, Hsu LF, et al. Technique and results of linear ablation at the mitral isthmus. Circulation,2004,110:2996-3002
[10] Calkins H,Brugada J,Packer DL,et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation:recommendations for personnel,policy,procedures and follow-up. Heart Rhythm,2007,4:816-861
[11]蔡衡,杨延宗,高连君,等.肺静脉电隔离治疗持续性心房颤动方法学及效果评价.中华心律失常学杂志,2006,10:423-427
[12] Quyang F,Bansch D,Ernst S,et al.Complete isolation of left atrium surrounding the pulmonary veins:new insights from the double lasso technique in proxysmal atrial fibrillation.Circulation,2004,110:2090-2096
[13] Haissaguerre M,Sanders P,Hocini M,et al.Catheter ablation of long-lasting persistent atrial fibrillation:critical structures for termination.J Cardiovasc Electrophysiol,2005,16:1125-1137
[14] Nademanee K, McKenzie J, Kosar E, et al. A new approach for catheter ablation of atrial fibrillation:mapping of electrophysiologic substrate. J Am Coll Cardiol ,2004,43:2044-2053
[15] Ja?s P,Ha?ssaguerre M,Shah DC, et al. Regional disparities of endocardial atrial activation in paroxysmal atrial fibrillation.Pacing Clin Electrophysiol, 1996, 19(11 pt 2):1998-2003
[16] Verma A,Novak P,Macle L,et al. A prospective,multicenter evaluation of ablating complex fractionated electrograms (CFEs) during atrial fibrillation (AF) identified by an automated mapping algorithm: acute effects on AF and efficacy as an adjuvant strategy.Heart Rhythm,2008,5:198-205
[17] Oral H,Chugh A,Good E,et al. Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex Electrograms. Circulation,2007,115:2606-2612
[18] Nademanee K,Schwab M,Porath J,et al.How to perform electrogram-guided atrial fibrillation ablation. Heart Rhythm,2006,3:981-984
[19] Haissaguerre M,Sanders P,Hocini M,et al. Changes in atrial fibrillation cycle length and inducibility during catheter ablation and their relation to outcome. Circulation,2004,109:3007-3013
[20] Porter M,Spear W,Akar JG,et al. Prospective study of atrial fibrillation termination during ablation guided by automated detection of fractionated electrograms. J Cardiovasc Electrophysiol,2008,19:613-620
[21] Konings KT,Smeets JL,Penn OC,et al. Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans. Circulation,1997,95:1231-1241
[22] Scherlag BJ,Nakagawa H,Jackman WM,et al. Electrical stimulation to identify neural elements on the heart:their role in atrial fibrillation.J Interv Card Electrophysiol,2005,13:37-42
[23] Lin J,Scherlag BJ,Zhou J,et al. Autonomic mechanism to explain complex fractionated atrial electrograms (CFAE).J Cardiovasc Electrophysiol, 2007,18: 1197-1205
[24] Lemery R, Birnie D, Tang AS, et al. Feasibility study of endocardial mapping of ganglionated plexuses during catheter ablation of atrial fibrillation. Heart Rhythm,2006,3:387-396
[25] de Bakker JM,van Capelle FJ,Janse MJ,et al. Fractionated electrograms in dilated cardiomyopathy:origin and relation to abnormal conduction.J Am Coll Cardiol,1996,27:1071-1078
[26] Jacquemet V, Virag N, Ihara Z, et al.Study of unipolar electrogram morphology in a computer model of atrial fibrillation.J Cardiovasc Electrophysiol, 2003,14: S172-179
[27] Kalifa J,Tanaka K,Zaitsev AV,et al. Mechanisms of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of theisolated sheep heart during atrial fibrillation. Circulation,2006,113:626-633
[28] Crawford TC,Wimmer A,Dey S,et al. Mechanism of recurrence after radiofrequency catheter ablation of atrial fibrillation guided by complex fractionated atrial electrograms.J Interv Car Electrophysiol, 2008,21:27-33
[29] Nademanee K. Trials and travails of electrogram-guided ablation of chronic atrial fibrillation.Circulation,2007,115:2592-2594
[30] Scherr D, Dalal D, Cheema A, et al.Automated detection and characterization of complex fractionated atrial electrograms in human left atrium during atrial fibrillation.Heart Rhythm,2007,4:1013-1020
[1]周自强,胡大一,陈捷,等.中国心房颤动现状的流行病学研究.中华内科杂志, 2004,43:491-494
[2] Prystowsky EN, Benson DW Jr, Fuster V, et al. Management of patients with atrial fibrillation:A statement for healthcare professionals from the subcommittee on electrocardiography and electrophysiology, American Heart Association. Circulation, 1996,93 :1262 - 1277
[3] Cappato R, Calkins H, Chen SA, et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation[ J ]. Circulation, 2005,111: 1100 -1105
[4] Nademanee K,McKenzie J,Kosar E,et al.A new approach for catheter ablation of atrial fibrillation:mapping of the electrophysiologic substrate.J Am Coll Cardiol,2004,43:2044 -2053
[5] Moe GK, Abildskov JA. Atrial fibrillation as a self - sustained arrhythmia independent of focal discharge. Am Heart J, 1959, 58:59-70
[6] HaissaguerreM, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998, 339: 659-666
[7] Arentz T, Jander N, von Rosenthal J, et al. Incidence of pulmonary vein stenosis 2 years after radiofrequency catheter ablation of refractory atrial fibrillation[ J ]. Eur Heart J , 2003 , 24 : 963-969
[8] Saad EB,Rossillo A,Saad CP,et al. Pulmonary vein stenosis after radiofrequency ablation of the atrial fibrillation :functional charterization,evolution,and influence of the ablation strategy.Cirulation 2003,108:3102-3107
[9] Pappone C, Rosanio S, Oreto G,et al. Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation.Circulation,2000,102:2619-2628
[10] Karch MR, Zrenner B, Deisenhofer I, et al. Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation: A randomized comparison between 2 current ablation strategies. Circulation, 2005,111:v 2875- 2880
[11] Hocini M, Jais P, Sanders P, et al. Techniques, evaluation, and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation: A prospective randomized study. Circulation,2005,112:3688 -3696
[12] Jais P, Hocini M, Hsu LF, et al. Technique and results of linear ablation at the mitral isthmus. Circulation,2004,110:2996-3002
[13] Pappone C, Manguso F, Vicedomini G, et al. Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation: A prospective randomized study comparing circumferential pulmonary vein ablation with a modified approach. Circulation,2004,110:3036 -3042
[14] Calkins H, Brugada J, Packer DL,et al. HRS/EHRA/ECAS Expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up:A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation.Heart Rhythm, 2007 ,4:816-861
[15] Pappone C, Santinelli V, Manguso F, et al. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation. Circulation,2004,109:327–334
[16] Oral H, Chugh A, Good E,et al. A tailored approach to catheter ablation of paroxysmal atrial fibrillation. Circulation,2006,113:1824-1831
[17] Ha?ssaguerre M, Sanders P, Hocini M, et al.Catheter ablation of long-lasting persistent atrial fibrillation: Critical structures for termination.J Cardiovasc Electrophysiol,2005, 16:1125-1137
[18] Ha?ssaguerre M, Hocini M, Sanders P,et al.Catheter Ablation of Long-Lasting Persistent Atrial Fibrillation:Clinical outcome and mechanisms of subsequent arrhythmias. J Cardiovasc Electrophysiol. 2005,16:1138-1147
[19] Fuster V, Rydén LE, Cannom DS,et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.Circulation, 2006, 114:e257–354
[20] Nademanee K,Schwab M,Porath J,et al. How to perform electrogram-guided atrial fibrillation ablation. Heart Rhythm,2006,3:981-984
[21] Konings KT,Smeets JL,Penn OC,et al.Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans. Circulation, 1997,95:1231-1241
[22] Scherlag BJ,Nakagawa H,Jackman WM,et al. Electrical stimulation to identify neural elements on the heart:their role in atrial fibrillation. J Interv Card Electrophysiol,2005,13:37-42
[23] Lin J,Scherlag BJ,Zhou J,et al. Autonomic mechanism to explain complex fractionated atrial electrograms (CFAE).J Cardiovasc Electrophysiol, 2007, 18:1197-1205
[24] Lemery R, Birnie D, Tang AS, et al.Feasibility study of endocardial mapping of ganglionated plexuses during catheter ablation of atrial fibrillation. Heart Rhythm,2006,3:387-396
[25] de Bakker JM,van Capelle FJ,Janse MJ,et al. Fractionated electrograms in dilated cardiomyopathy:origin and relation to abnormal conduction.J Am Coll Cardiol,1996,27:1071-1078
[26] Jacquemet V, Virag N, Ihara Z, et al.Study of unipolar electrogram morphology in a computer model of atrial fibrillation.J Cardiovasc Electrophysiol, 2003,14:S172-179
[27] Kalifa J,Tanaka K,Zaitsev AV,et al. Mechanisms of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of the isolated sheep heart during atrial fibrillation. Circulation,2006,113:626-633
[28] Rostock T, Rotter M, Sanders P,et al. High-density activation mapping of fractionated electrograms in the atria of patients with paroxysmal atrial fibrillation[ J ]. Heart Rhythm,2006,3:27-34
[29] Scherr D, Dalal D, Cheema A,et al. Automated detection and characterization of complex fractionated atrial electrograms in human left atrium during atrial fibrillation[ J ]. Heart Rhythm,2007,4:1013–1020
[30] Oral H,Chugh A,Good E, et al. Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex Electrograms.Circulation, 2007,115: 2606-2612
[31] Verma A,Novak P,Macle L,et al. A prospective, multicenter evaluation of ablating complex fractionated electrograms (CFEs) during atrial fibrillation (AF) identified by an automated mapping algorithm: acute effects on AF and efficacy as an adjuvant strategy[ J ].Heart Rhythm 2008,5:198-205
[32] Schmitt C,Estner H,Hecher B,et al. Radiofrequency ablation of complex fractionated atrial electrograms (CFAE): Preferential sites of acute termination and regularization in paroxysmal and persistent atrial fibrillation[ J ].J Cardiovasc Electrophysiol,2007,18:1039-1046
[33] Porter M,Spear W,Akar JG,et al. Prospective study of atrial fibrillation termination during ablation guided by automated detection of fractionated electrograms.J Cardiovasc Electrophysiol, 2008,19: 613-620
[2] Arentz T, Jander N, von Rosenthal J, et al. Incidence of pulmonary vein stenosis 2 years after radiofrequency catheter ablation of refractory atrial fibrillation. Eur Heart J,2003,24 : 963-969
[3] Oral H, Knight BP, Ozaydin M, et al. Segmental ostial ablation to isolate the pulmonary veins during atrial fibrillation: feasibility and mechanistic insights.Circulation,2002,106:1256-1262
[4] Haissaguerre M, Jais P ,Shah DC, et al. Catheter ablation of chronic atrial fibrillation targeting the reinitiating triggers. J Cardiovasc Electrophysiol, 2000, 11: 2-10
[5] Oral H, Knight BP, Tada H, et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation, 2002, 105:1077-1081
[6] Pappone C, Rosanio S, Oreto G,et al. Circumferential radiofrequency ablation of pulmonary vein ostia: A New Anatomic Approach for Curing Atrial Fibrillation. Circulation,2000,102:2619-2628
[7] Arentz T, von Rosenthal J, Blum T,et al. Feasibility and safety of pulmonary vein isolation using a new mapping and navigation system in patients with refractory atria fibrillation. Circulation, 2003,108:2484-2490
[8] Hocini M, Jais P, Sanders P, et al. Techniques, evaluation, and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation: a prospective randomized study. Circulation,2005,112:3688 -3696
[9] Jais P, Hocini M, Hsu LF, et al. Technique and results of linear ablation at the mitral isthmus. Circulation,2004,110:2996-3002
[10] Calkins H,Brugada J,Packer DL,et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation:recommendations for personnel,policy,procedures and follow-up. Heart Rhythm,2007,4:816-861
[11]蔡衡,杨延宗,高连君,等.肺静脉电隔离治疗持续性心房颤动方法学及效果评价.中华心律失常学杂志,2006,10:423-427
[12] Quyang F,Bansch D,Ernst S,et al.Complete isolation of left atrium surrounding the pulmonary veins:new insights from the double lasso technique in proxysmal atrial fibrillation.Circulation,2004,110:2090-2096
[13] Haissaguerre M,Sanders P,Hocini M,et al.Catheter ablation of long-lasting persistent atrial fibrillation:critical structures for termination.J Cardiovasc Electrophysiol,2005,16:1125-1137
[14] Nademanee K, McKenzie J, Kosar E, et al. A new approach for catheter ablation of atrial fibrillation:mapping of electrophysiologic substrate. J Am Coll Cardiol ,2004,43:2044-2053
[15] Ja?s P,Ha?ssaguerre M,Shah DC, et al. Regional disparities of endocardial atrial activation in paroxysmal atrial fibrillation.Pacing Clin Electrophysiol, 1996, 19(11 pt 2):1998-2003
[16] Verma A,Novak P,Macle L,et al. A prospective,multicenter evaluation of ablating complex fractionated electrograms (CFEs) during atrial fibrillation (AF) identified by an automated mapping algorithm: acute effects on AF and efficacy as an adjuvant strategy.Heart Rhythm,2008,5:198-205
[17] Oral H,Chugh A,Good E,et al. Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex Electrograms. Circulation,2007,115:2606-2612
[18] Nademanee K,Schwab M,Porath J,et al.How to perform electrogram-guided atrial fibrillation ablation. Heart Rhythm,2006,3:981-984
[19] Haissaguerre M,Sanders P,Hocini M,et al. Changes in atrial fibrillation cycle length and inducibility during catheter ablation and their relation to outcome. Circulation,2004,109:3007-3013
[20] Porter M,Spear W,Akar JG,et al. Prospective study of atrial fibrillation termination during ablation guided by automated detection of fractionated electrograms. J Cardiovasc Electrophysiol,2008,19:613-620
[21] Konings KT,Smeets JL,Penn OC,et al. Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans. Circulation,1997,95:1231-1241
[22] Scherlag BJ,Nakagawa H,Jackman WM,et al. Electrical stimulation to identify neural elements on the heart:their role in atrial fibrillation.J Interv Card Electrophysiol,2005,13:37-42
[23] Lin J,Scherlag BJ,Zhou J,et al. Autonomic mechanism to explain complex fractionated atrial electrograms (CFAE).J Cardiovasc Electrophysiol, 2007,18: 1197-1205
[24] Lemery R, Birnie D, Tang AS, et al. Feasibility study of endocardial mapping of ganglionated plexuses during catheter ablation of atrial fibrillation. Heart Rhythm,2006,3:387-396
[25] de Bakker JM,van Capelle FJ,Janse MJ,et al. Fractionated electrograms in dilated cardiomyopathy:origin and relation to abnormal conduction.J Am Coll Cardiol,1996,27:1071-1078
[26] Jacquemet V, Virag N, Ihara Z, et al.Study of unipolar electrogram morphology in a computer model of atrial fibrillation.J Cardiovasc Electrophysiol, 2003,14: S172-179
[27] Kalifa J,Tanaka K,Zaitsev AV,et al. Mechanisms of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of theisolated sheep heart during atrial fibrillation. Circulation,2006,113:626-633
[28] Crawford TC,Wimmer A,Dey S,et al. Mechanism of recurrence after radiofrequency catheter ablation of atrial fibrillation guided by complex fractionated atrial electrograms.J Interv Car Electrophysiol, 2008,21:27-33
[29] Nademanee K. Trials and travails of electrogram-guided ablation of chronic atrial fibrillation.Circulation,2007,115:2592-2594
[30] Scherr D, Dalal D, Cheema A, et al.Automated detection and characterization of complex fractionated atrial electrograms in human left atrium during atrial fibrillation.Heart Rhythm,2007,4:1013-1020
[1]周自强,胡大一,陈捷,等.中国心房颤动现状的流行病学研究.中华内科杂志, 2004,43:491-494
[2] Prystowsky EN, Benson DW Jr, Fuster V, et al. Management of patients with atrial fibrillation:A statement for healthcare professionals from the subcommittee on electrocardiography and electrophysiology, American Heart Association. Circulation, 1996,93 :1262 - 1277
[3] Cappato R, Calkins H, Chen SA, et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation[ J ]. Circulation, 2005,111: 1100 -1105
[4] Nademanee K,McKenzie J,Kosar E,et al.A new approach for catheter ablation of atrial fibrillation:mapping of the electrophysiologic substrate.J Am Coll Cardiol,2004,43:2044 -2053
[5] Moe GK, Abildskov JA. Atrial fibrillation as a self - sustained arrhythmia independent of focal discharge. Am Heart J, 1959, 58:59-70
[6] HaissaguerreM, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998, 339: 659-666
[7] Arentz T, Jander N, von Rosenthal J, et al. Incidence of pulmonary vein stenosis 2 years after radiofrequency catheter ablation of refractory atrial fibrillation[ J ]. Eur Heart J , 2003 , 24 : 963-969
[8] Saad EB,Rossillo A,Saad CP,et al. Pulmonary vein stenosis after radiofrequency ablation of the atrial fibrillation :functional charterization,evolution,and influence of the ablation strategy.Cirulation 2003,108:3102-3107
[9] Pappone C, Rosanio S, Oreto G,et al. Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation.Circulation,2000,102:2619-2628
[10] Karch MR, Zrenner B, Deisenhofer I, et al. Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation: A randomized comparison between 2 current ablation strategies. Circulation, 2005,111:v 2875- 2880
[11] Hocini M, Jais P, Sanders P, et al. Techniques, evaluation, and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation: A prospective randomized study. Circulation,2005,112:3688 -3696
[12] Jais P, Hocini M, Hsu LF, et al. Technique and results of linear ablation at the mitral isthmus. Circulation,2004,110:2996-3002
[13] Pappone C, Manguso F, Vicedomini G, et al. Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation: A prospective randomized study comparing circumferential pulmonary vein ablation with a modified approach. Circulation,2004,110:3036 -3042
[14] Calkins H, Brugada J, Packer DL,et al. HRS/EHRA/ECAS Expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up:A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation.Heart Rhythm, 2007 ,4:816-861
[15] Pappone C, Santinelli V, Manguso F, et al. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation. Circulation,2004,109:327–334
[16] Oral H, Chugh A, Good E,et al. A tailored approach to catheter ablation of paroxysmal atrial fibrillation. Circulation,2006,113:1824-1831
[17] Ha?ssaguerre M, Sanders P, Hocini M, et al.Catheter ablation of long-lasting persistent atrial fibrillation: Critical structures for termination.J Cardiovasc Electrophysiol,2005, 16:1125-1137
[18] Ha?ssaguerre M, Hocini M, Sanders P,et al.Catheter Ablation of Long-Lasting Persistent Atrial Fibrillation:Clinical outcome and mechanisms of subsequent arrhythmias. J Cardiovasc Electrophysiol. 2005,16:1138-1147
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