手术消融手术技术和临床试验结果及东西方比较(中英文）.pptVIP

AF Is Common 2.8 Million AF in USA - 0.9% population 300 million 160,000 new cases annually Prevalence increased in elderly and RHD 700000 strokes annually 140000(20%) strokes from AF Consequences of AF Not life-threatening disease Stroke: devastating complications Mortality: 2x expected for general population Costly condition, strong need for cure No widely accepted treatment available AF ABLATION VS CUT SEW: Bioplar RF creates linear, transmural lesions in dogs (Prasad et al, 2003) Bipolar RF can replace surgical incisions in Cox Maze III (Damiano et al 2004) Bipolar RF can replace surgical incisions in Cox Maze III in multicentre trials ( Barns, Cleveland Clinic, Dallas) Bipolar RF can replace surgical incisions of Cox Maze III in CABG/CPB patients (Khargi et al 2004) Sequential Endocardial and Epicardial Irrigated Monopolar Ablation to ensure transmurality What type of results one expect to get Study interval: Oct 2002 – Dec 2003 44 patients: 30 MVR/Repair, 10 MVR + AVR, 2 CABG, 2 ASD Mortality: (2 patients ) 1 MVR, 1 MVR + AVR Average age: 45 years ( range 22 – 60 years ) Average LA diameter: 51mm ( range 45 – 62 mm ) AF type: All chronic and 1 year Follow up duration: 4 – 5 years Result: 34/42 in SR ( 81%). Atrial contraction ( M-mode echo ): LA 70%, RA 90% No stroke, no late mortality Restudy of failure: 6 Patients 4/6 patient has left atrial flutter involving left atrial isthmus * * 0 5 10 15 20 25 30 35 40 Greater Japan Singapore Malaysia Indonesia Vietnam Thailand China US Dollars 34312 35163 6948 1925 818 3737 2461 GPD ( nominal) per capital In China the monopolar device which can create all the lines of the Cox Maze III can cost up to almost a year of personal income. Because of cost consideration can be important, only one device is affordable in developing countries The issue then if the monopolar RF pen is to be