Andrea Natale 美国德州圣大卫医疗中心心律失常研究所  

执行医务总监   

<International Circulation>: What are some of the new emerging ablation technologies that can be used in clinical practice?

  《国际循环》：有哪些新的消融技术可以用于临床实践？

    Dr Natale: In general， especially when we talk about complex ablation procedures like atrial fibrillation， ventricular tachycardia and structural heart disease， one of the big challenges that operators face is to get to the site where they need to be efficiently， so they don’t need to spend a lot of time unnecessarily. The major challenge that we have today is to be able to provide these complex procedures in every lab without the need for a very experience operator. One of the technologies that is supposed to bridge this gap between the experience of the operator and the complexity of the procedure is remote navigation. There are two forms that are available today – one is magnetic navigation and the other is true robotic navigation where there is a robotic sheath through which any catheter can be fed and advanced into the cardiac chamber. It is a way to overcome the potential lack of experience or skill. Other technologies that are becoming available now are balloon procedures which are limited to a subgroup of patients with atrial fibrillation. Typically， people who do well with a balloon procedure are paroxysmal patients with no structural heart disease and very short-lasting episodes. But it is another example of technology accommodating a procedure which would otherwise require a significant amount of skill and experience. Those are technologies that are already available. If we look at technologies that are becoming available， certainly something that is very important are contact force sensors. We all know that what makes a good permanent lesion is the ability to achieve good contact between the catheter and the tissue and right now we only have indirect measurement s to follow. Part of that is really driven by the experience of the operator again. Now this catheter is going to be able to provide an objective measurement of contact pressure and there is already evidence that that can make a difference. When you do a procedure and your contact is below a certain number， your chances of success become very small. Whereas if you are able to achieve a more stable higher contact pressure throughout the procedure then the chances of a successful procedure become higher. That technology is going to be available either in clinical studies or is already available in Europe where they promise to offer the opportunity for better success in doing complex procedures. Another example of this kind of technology is called microwave radiometry which gives us real time information of lesion growth by looking at the thermometry of the tissue as you deliver energy. This is now entering preliminary human testing and the results we are seeing are really encouraging. Some of us feel this can be another source of information of good lesion achievement that certainly is going to have some impact on the long-term success of the procedure.

    Natale博士：通常情况下，尤其当我们讨论复杂的消融过程类似房颤、室性心动过速和器质性心脏病的时候，术者面临的一个巨大的难题是如何直接的到达有效的手术位置，从而避免花费不必要的时间。目前我们面临的巨大的挑战是在每个的实验室开展这种复杂的过程，同时不需要非常熟练有经验的操作者。远程导航是弥补操作者经验和操作过程复杂之间差距的技术之一，现今已经上市的有两种形式，一种是磁导航，另一种是真正的机械导航，机械导航有一个机械鞘，任何导管可以通过它进入心腔。这正是克服可能存在的经验和技术缺乏的一种方式。目前其他的可以利用的技术就是球囊程序，但这一技术仅限于房颤病人的亚群。具有代表性的对球囊过程疗效显著的是那些没有器质性心脏病并且发作过程极短的阵发性房颤病人。但从另一个方面来说它包含了一个过程，如果不这么做的话可能需要大量的技术和经验，以上就是目前可以利用的技术。如果我们观察这些可利用的技术，在其中可以肯定的是接触压力传感器是非常重要的。众所周知的是在导管和心脏组织之间建立一个良好的接触是造成永久性阻滞的关键，但到目前为止我们只有间接地心脏测量软件可以利用。这一部分确实再次需要在术者的经验下进行，能提供接触压力的客观测量数据的导管已经被证明将会有所作为。当你进行一项接触点低于一定数量的手术时，你获得成功的机会就变的很渺茫。而如果在整个过程中能够达到更高更稳定的接触力，那么手术的成功率也将会提高。无论是在临床研究还是在欧洲的实际应用（上市），这项技术将是非常有用的，他们承诺提供更好的成功进行复杂手术的机会。另外一个此类技术的实例是微波辐射测计，它通过监测由身体提供能量得组织的温度来提供病灶生长的实时信息。目前这一技术初步进入人体测试阶段并且我们得到的结果是非常令人鼓舞的。我们有部分的专家学者认为这是良性病变另一个信息来源的完成，非常确定的是这将会对手术的长远的成功产生影响。

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