There are many hypotheses about the theory of atrial fibrillation. Why is it called "hypothesis"? Just not sure. What the doctor said to the patient sounds very positive, but in fact, the doctor has no bottom in his heart, which is the case all over the world. Just as adults teach children that this is right and that is wrong, but in fact many adults are not sure what is right.
Before I say these hypotheses, I want to emphasize the explanation of the mechanism of atrial fibrillation: the nerves in the atrium are in a mess and discharge conduction.
There are three hypotheses and four hypotheses about atrial fibrillation.
These three hypotheses are: multi-carrier meandering hypothesis, local excitation theory, and dominant reentrant loop theory with trembling-like conduction.
The four hypotheses are: the electrical structure and matrix of pulmonary veins, the electrical matrix of atrial fibrillation, the autonomic nervous factors of the heart, and atrial fibrillation fossa.
These hypotheses were discovered and put forward a few years later, and then another one was studied and put forward a few years later. They are all put forward as new discoveries one by one. Whoever puts forward a hypothesis will invent a radio frequency method, and finally find that it is not ideal, and then continue to study. We don't have much contact with each other, which is also the characteristic of western medicine. If a person is hospitalized because of heart disease, he or she has hyperglycemia, stomachache, headache and upset, he or she should consult the endocrinology department, gastroenterology department, neurology department and psychology department. Without consultation, he won't treat the disease.
Today, I carefully summarized these assumptions into a whole.
First of all, there is always a place to discharge first, make trouble first, and have leadership. This is the "local excitation theory";
Any successful troublemaker must have a core member to do the core thing (if no one responds after the focus is excited, it is premature beat, jump by himself), and this focus excitement (that is, premature beat) will turn around along a core road and do it yourself, which is the "leading turn-back ring";
If you want to do great things, you can't just rely on the core team. There are also countless small teams fighting together in the periphery, such as small bandits and the Imperial Association Army. They obey the command of the main force and work together around the main force. These small teams have their own command core and their own sphere of influence. That is to say, with the dominant reentrant loop as the core, there will be many "small reentrant loops", and each small reentrant loop will form its own electric wave (we are talking about ECG), which is the "multi-carrier meandering hypothesis"; A "local excitement" who took the lead in making trouble and screamed at the core team responded. The water flow turns around to form a "leading reentry ring", and many small teams form a "small reentry ring" around the leading reentry ring. The radio waves formed by the "small foldback loop" are called "multiwavelets". This began to tremble.
These are three main assumptions.
People who love to make trouble all have regional characteristics. Pulmonary veins lead to the left atrium, veins are blood vessels, and atrium is muscle. The muscle must wrap the blood vessels where it is planted, and the blood vessels wrap the atrial muscles of pulmonary veins. This knot in one's heart is troublesome. The muscles and electrical properties of this place are different, and it has deteriorated, that is, "the electrical structure and matrix of pulmonary vein (deterioration hypothesis)";
It is easy to make trouble from the pulmonary vein (main, not absolute, not unique). Where did the bandits and the Imperial Association Army come from? From places with unstable or no base areas, the people in these places have deteriorated, that is, many atrial muscle tissues have deteriorated, and the corresponding electrical conductivity has also deteriorated. This is "atrial fibrillation electrical matrix of atrial tissue (deterioration hypothesis)";
Some bandits' nests were set on fire. Give a small look, pick up the gun and go out and fight for your life. It is particularly easy to get excited and tremble. This is the "atrial fibrillation nest";
All parts of the heart are innervated by nerves which extend in all directions. When the nerve command is good, the place will be stable; If the command is not good, it will be unstable; Blind command is also unstable; In the accident-prone pulmonary veins and atrial fibrillation nests on fire, the positive function of nerves is not enough, either too weak or defective. This is the hypothesis of cardiac autonomic nervous factors.
Tip: Think about TV dramas and novels about war. Think it over. Everything is in harmony.
There are so many mechanisms about atrial fibrillation that I won't go into details. I have dealt with the above, and the result is scattered in thousands of articles, which is not systematic.
History and Evolution of Radiofrequency Therapy for Atrial Fibrillation 199 1 year, a foreign surgeon invented the maze operation, which was completed by surgery;
1994 on the basis of the above operations, there is catheter radiofrequency ablation, which is done by internal medicine, intubation and no operation;
From 65438 to 0998, radiofrequency ablation of pulmonary veins began to develop.
1999, total atrial ablation except pulmonary vein;
……
Among them, a hundred flowers blossom, because the principle of ablation is to burn and scald normal myocardium! So, useful laser, useful freezing, useful ultrasonic, useful radio frequency and different energy are all burning anyway!
……
Then, then, until now, the whole world is exploring and trying various "burning methods".
First, attach the schematic diagram of RF:
Briefly talk about these explorations:
The principle of the surgical maze is: cage tactics, which separate bandits from the imperial association army by railways and highways. Even if we are apart, we will tremble, but we will not shake badly. This can't change the essence of tremor, just let a few small tremors have nothing to do with big tremors;
Because most of the troublemakers are at the junction of pulmonary vein and atrium, pulmonary vein ablation is to burn a circle along the pulmonary vein, so that the telex of the troublemaker can not come. Isn't your village dishonest Digging a deep ditch around the village can only make trouble in the village, not out of the village. Medically, it is called "complete electrical isolation", which means that it is completely burned to death and there is no electricity to transmit. The problem is that it is extremely difficult to burn completely. If it is not completely burned, it will leak electricity (white burning). There will be scars after burning. Scar is shrinking, which will narrow the pulmonary vein. Pulmonary vein stenosis will certainly lead to many new problems. In short, the effect is not very satisfactory.
Then people found that not only the muscles around the pulmonary vein had problems, but also the area in front of the pulmonary vein. It was not a village that had a problem, but a village that had the most trouble and the surrounding villages were not very good, so it began to burn all the surrounding villages. But I found that the effect was not good, but it was poorly completed and will not be good in the future!
The effect is not good, but it is not difficult to burn! Therefore, on the premise of burning pulmonary veins at one time, we began to burn three lines and dig three trenches in the whole atrium. I want to separate the main force from the bandit emperor association army in this way, but there are also problems. Without these three lines, atrial tachycardia is easy to occur after radiofrequency surgery (atrial fibrillation is gone, but atrial tachycardia is increased). Adding these three wires can improve the success rate of radiofrequency in atrial fibrillation and reduce atrial tachycardia after operation. But, but, but these three lines should be burned thoroughly, and no good meat should be left (good meat can conduct electricity). Incomplete combustion will lead to electric leakage, which is more likely to cause room speed! This is called two circles and three lines, and two circles and three lines are burned, but you can't burn anywhere, you must burn it through! Still not satisfied.
On the basis of the Second Ring Road and the Third Line, some Japanese people have adopted a more brilliant "Three Lights" policy, which completely burned up and down. Now some hospitals are doing this, and the effect is not sure.
Some paroxysmal atrial fibrillation, a small part is not caused by the defect of pulmonary vein and atrial graft, but from other places. When using radio frequency, burn it directly in that place, which was effective at that time. But there is a rule that there are bad people everywhere. When the bandits' nest is over, small bandits will be ready to move. You can't lift the gourd unless you press it. Press the gourd, you can't get up tomorrow today, and you can't get up the day after tomorrow.
In 2004, a foreigner came up with a method to kill the village, which was not to dig ditches around the village, but to burn the whole village. It was medically called "fragmentation potential ablation" and euphemistically called "atrial matrix improvement", just like ethnic improvement. Of course, the heart muscle must have been burned to death. This method is to think about clearing the enemy. I didn't expect to fight in my own country, kill traitors in my own country with nuclear bombs, and blow up cities that have been polluted by nuclear pollution for many years. The point is, the effect is not good, and the success rate of RF is only 33% after one year.
The relationship between cardiac sympathetic nerve and atrial fibrillation is very close, which is recognized all over the world (this is the theoretical basis of Beijing Charity Hall, and Ma has been studying this for nearly 20 years). So someone burned the nerve in the atrium. Last year, the charity hall met two patients with atrial fibrillation. One patient cut off the nerve by surgery, and the other patient was burned by radio frequency in internal medicine. The result is still shivering! Nerves are controlled by discharge and conduction, because one messenger becomes a traitor and kills all messengers, which is not acceptable. Not even a good messenger. To maintain good order, we still need a lot of good messengers.
People couldn't bear it, so they killed their old master with one punch. All the above-mentioned items were completely burned. After inspection, we found a living knife patch ... This name is "gradual individualized ablation strategy", which has a high success rate (all of them were burned to death, and the atrium almost burned, so they stopped shaking), but there are many atrial tachycardia, which is atrial tachycardia. In fact, for patients, atrial tachycardia is not much different from atrial fibrillation. Because of the intense combustion, the left atrial appendage often burns completely without electricity and exercise (medically called complete electrical isolation), and running water does not rot. If the left atrial appendage does not move, it is easy to form a thrombus. So now many hospitals have removed the left atrial appendage after radiofrequency ablation, and the atrium is burning sparsely. Dare you not take anticoagulants? ! All burned places should be scarred, which is easy to form blood clots.
……
There are many RF modes in the world, all of which are different combinations of the above. Some don't work, some say yes but not credible (not that I don't believe it, but that western medicine experts don't believe it).
Now the radio frequency of hospitals all over the country is not outside this circle.
The efficacy and side effects of radiofrequency treatment of atrial fibrillation (everyone is most concerned about! It is difficult to write the curative effect. To say the curative effect, we must first understand the criteria for judging the curative effect. How to be effective? What is effective? What is effective? I looked up a lot of information (formal academic information, read by doctors). As a result, I once again verified what I always knew: there is no clear standard!
First, the evaluation criteria of "the efficacy of radiofrequency in the treatment of atrial fibrillation"
In 1 and 20 16, I checked some articles and found that the standard of curative effect evaluation in regular public hospitals is "atrial fibrillation does not exceed 5 minutes within 24 hours after radiofrequency". That is to say, after the radio frequency ended, 1 day had 10 atrial fibrillation, each time for 4 minutes and 58 seconds, and it was successful! Note: I believe my memory, but I can't find this article today! I checked countless medical papers, and no one mentioned them! How to calculate premature beats, atrial tachycardia and paroxysmal supraventricular tachycardia after radiofrequency? Nobody mentioned this!
2. At present, the standard definition of RF success in some hospitals in China is: "no atrial fibrillation attack or antiarrhythmic drugs that are less than 1 time per month and last for no more than 1 minute, and have not been used or have been ineffective before use". In other words, if you don't use western medicine, or use western medicine before RF, you will still use it after RF. In this case, after the radio frequency is finished, it does not shake, or although it shakes, it is less than 1 time a month, and each time is less than one minute. This is a success! How to calculate premature beats, atrial tachycardia and paroxysmal supraventricular tachycardia after radiofrequency? Nobody mentioned this! Why did I mention it? Due to contact with a large number of patients, frequent premature beats, atrial tachycardia and paroxysmal supraventricular tachycardia occur after radiofrequency. The patient must think it is unsuccessful. I don't know what is this in the hospital where RF is done.
3. atrial fibrillation guideline 20 15 (what is a guideline? What are the guidelines? We'll discuss them later.) Say:
The definition of RF success is: "After 3 months of RF, there is no atrial fibrillation, atrial flutter and atrial tachycardia".
What if there are frequent rooms early? Didn't say! Since I didn't say that there were no atrial fibrillation, atrial flutter and atrial tachycardia after the filming, but there were a lot of frequent ventricular premature beats or paroxysmal supraventricular tachycardia, it must be successful.
Recurrence of atrial fibrillation: Atrial fibrillation, atrial flutter and atrial tachycardia occurred after 3 months of radio frequency. If the duration is ≥30 seconds, it is regarded as recurrence of atrial fibrillation.
In other words, if it lasts for 20 seconds each time, whether you are 1 episode or 100 episode a day, it is not a recurrence. What about the first three months after RF? They defined 3 months after radiofrequency ablation of atrial fibrillation as a blank period, during which atrial fibrillation, atrial tachycardia and atrial flutter were not defined as recurrence.
You got it? Not counting the first 3 months after the end of radio frequency, and not counting each attack less than 30 seconds after 3 months!
The above is good, and there are more exciting standards. Just say one, foreign:
After 3 months of radiofrequency, the duration of atrial fibrillation and atrial flutter was less than 24 hours; No atrial arrhythmia, hospitalization and cardioversion lasting more than 30 s.
That means the first three months don't count. After three months, if atrial fibrillation occurs, it will be successful in less than 24 hours at a time. Or there is room speed but less than 30 seconds, which is considered successful; Or didn't come to the hospital, it was a success; Or not being shocked (few people shock atrial fibrillation now, yes, but very few), it is successful.
In short, the success standard of RF is different everywhere, and there is no way to know a clear statement!
What does the guide mean?
Many famous experts studied together, many, many, and agreed after the study and wrote a document. Anyway, martial arts experts discuss swords before making Jianghu rules.
For example:
In 20 12, the European heart association (ESC) published its "guidelines for diagnosis and treatment of atrial fibrillation";
20 14 American heart association, American heart association and rhythm association issued 20 14 guidelines for diagnosis and treatment of patients with atrial fibrillation;
Then on 20 14, Canada published the revised guidelines for atrial fibrillation to revise the previous guidelines!
China also has its own guidebook, and so does Japan. Most of us in China listen to the United States.
Rules made by many, many big experts are called guidelines. If the number of experts is not too much and the tour guides are not qualified, it doesn't matter. It is called "expert knowledge". It has the same meaning as the guide, but the strength is similar. Radio frequency, drugs, and medical insurance are all related to this. The country's money cannot be squandered. Most experts think it should be, and the state will reimburse it. There will be many associations in it.
These guides are very interesting. Sometimes Europe and the United States are completely opposite, not completely opposite, but completely opposite in a certain angle. So there is a saying that "follow the guide and you can't find the north."
Make do with the standard of curative effect, it's time to say curative effect.
The efficacy of radiofrequency in the treatment of atrial fibrillation has undergone standard torture, but it is not over yet. Let's move on. Before seeing the curative effect, state it again, regardless of how the curative effect is calculated. Let's just have a look. I'll list some first, and everyone will know what's going on:
A man named Capato said in 2009 that the success rate of paroxysmal atrial fibrillation was 83.2% and that of persistent atrial fibrillation was 75%. The European Heart Rhythm Association (EHRA) studied 72 hospitals in Europe 10 countries, and said the success rate was 30.2%.
The buddy at the Hamburg Center in Germany said: After a radio frequency, the five-year success rate is 20.3%, and the multi-shot success rate is 40.5%;
Another foreigner also studied it for five years (after radio frequency observation for five years) and said: 1 time has a success rate of 20%, and the success rate of multiple radio frequencies is 45%;
There is a study called RASTA, which studied 1 year (the longer the research cycle, the more time-consuming and laborious it is), and said that the success rate is 49%, 58% and 29% (the success rate corresponds to three different situations, so I won't go into details, let's take a look);
According to the New England Journal of Medicine, 12 countries have been studied and observed for10.5 years, and the success rates are 59%, 49% and 46% respectively (three different RF modes correspond to three numbers);
..... you know what? ……
As for China, in 20 16, the experts I personally recognized said that the success rate there was 52.438+0% and 67%.
In short, the effects of radio frequency are different. If you want to know a clear statement, or, no way!
This was last year and the year before last. ...
I wrote this article this year and spent a lot of effort looking up a lot of information. I found that the success rate of RF in China has advanced rapidly. Many hospitals say that the success rate is over 90%, and they are well-known public hospitals in the top three (I still have photos here, so I won't post them). Direct publicity for patients. Of course, it still belongs to the nature of popular science, and the professional literature I checked is not that high.
When looking at the curative effect, we should also pay attention. Patients go home after radiofrequency, and some go back to the hospital for regular examination. Some doctors called to ask; Some can't be contacted; Some atrial fibrillation is unknown to them; Patients can't carry Holt every day. Some patients have no symptoms before radiofrequency and no symptoms after radiofrequency. You don't know if he is shivering, which is inevitable in study.
Side effects of atrial fibrillation I first published the results in an academic literature, and then wrote some of our own findings.
Side effects are basically divided into three situations: puncture (puncture of catheter into blood vessels is called puncture), catheter puncture and electric discharge cautery.
The side effects of vascular puncture include: local bleeding, hematoma and infection; Pneumothorax (lung perforation); Thrombosis, embolism, etc.
The main reasons of catheter puncture are: aortic regurgitation, myocardial perforation (atrial muscle is actually quite thin, the puncture force is too strong), pericardial tamponade and so on.
Caused by radio frequency discharge: atrioventricular block (accidental injury to normal channels, only pacemaker can be installed), myocardial infarction, etc.
24 countries 52 1 hospital, *** 16309 case statistics show that:
Explanation:
Stroke is cerebral thrombosis, TIA is transient cerebral infarction, and there may be a small thrombus blocked and opened again. Thrombosis is the main cause of stroke and TIA, and appropriate anticoagulant therapy should be carried out after ablation.
Atrial tachycardia, premature beats, paroxysmal supraventricular tachycardia, etc. Complications, recurrence or failure after radiofrequency ablation are not counted, but they are actually quite a lot.
Let's talk about my own findings. Some patients have no energy after radiofrequency ablation, 1 patient has no energy after radiofrequency ablation. Up to now, seven years have passed, and my whole body is weak, just like major surgery. People all know that surgery hurts vitality, but they don't know that radiofrequency catheter will also hurt vitality. It's clear now. There is another one who has just finished doing nothing, and has become more and more bored since 3 months, lasting for more than 1 year.
People are refreshed when they encounter happy things, listless when they encounter problems, and frustrated and powerless when they encounter troubles.
Why is this? This is because the heart can certainly secrete some kind of positive energy. If the radio frequency burns the heart half to death and he can't secrete it, there will be problems. This secretion has been discovered by western medicine. For example, something called atrial natriuretic peptide has not only been discovered, but also synthetic drugs for treating heart failure, and the heart itself secretes something for treating heart failure. What do you mean? There are many positive things in my heart.
There are also some radio frequencies that make people uncomfortable. There are all kinds of discomforts, such as tingling in the precordial area, chest tightness, shortness of breath and so on. In fact, apart from the recurrence of atrial fibrillation, most of them are frequent premature beats and atrial tachycardia, and some of them are paroxysmal supraventricular tachycardia.
Debate and future of radiofrequency therapy for atrial fibrillation
I don't participate in the debate, but I am a porter of the debate and write a few words about the debate in the published medical papers.
One is that the results of clinical research all over the world are not the same as those in kind, and the in kind is worse than the research. This kind of real thing is called "real world research" in medical terms, and this kind of real thing research may become the mainstream of medical research in the future (the papers needed for doctors' promotion at present are called "evidence-based medical research").
For paroxysmal atrial fibrillation, it is still effective to burn a circle along the pulmonary vein (it is said at the beginning that it should be burned thoroughly, and it should be noted that a small part of paroxysmal atrial fibrillation does not take the lead in making trouble at the pulmonary vein transplantation), but the debate about catheter ablation of persistent atrial fibrillation has never stopped.
Atrial fibrillation has been RF for 20 years, from this theory to that theory, from this RF mode to that RF mode. However, the success rate of the existing methods is still not high, and there is still a long way to go in the future work.
On the morning of 20 16 and1.05, US time, the American Heart Association held a special meeting on atrial fibrillation at its scientific annual meeting on 20 16, and coffee people from all over the world gathered together to discuss the treatment of atrial fibrillation. A foreigner named Dr. Calkin thinks that atrial fibrillation ablation is unlikely to cure atrial fibrillation.
Professor Hu Dayi said: Radiofrequency ablation is doomed not to be the dominant mainstream solution for atrial fibrillation.
A famous expert in a famous hospital said in an interview with medical professional media that a few patients with economic conditions and willingness can try catheter ablation.
The above arguments are published in public, but most of them are in medical professional media, which is invisible to ordinary people. You have to register on professional websites, pay for downloads, and many of them are in English.
All the contents written in this paper have their origins, and come from researches all over the world. I didn't write it blindly, but I made it popular. Including my research on the treatment of atrial fibrillation by biological effects on cardiac sympathetic nerve, I didn't study it alone. This treatment is my research (the only one in China), but the relationship between cardiac sympathetic nerve and atrial fibrillation is very clear and has been studied a lot all over the world.
The Future of Radiofrequency Therapy for Atrial Fibrillation? I don't know
expect ...
To sum up: there are many pathogenesis of atrial fibrillation, all of which are hypotheses (the hypothesis is not necessarily wrong, in fact, I think it is basically right, but no one is watching it together);
There are many kinds of radio frequency methods, and they are constantly being refurbished;
The effective standard of radio frequency is not uniform;
Radio frequency and efficiency are not uniform, and there are great differences around the world;
What is said in the paper (medical professional paper) is not unified with reality;
There are different opinions in the European, American and Chinese guidelines;
The opinions of different experts are not uniform.
Ma Linbao replied.