【优质】欧阳非凡_Catheter_ablation_of_AF_in_the_last_10_Years.ppt

Catheter Ablation of Atrial Fibrillation in the Last 10 Years: Breakthroughs and Advances Dr. Feifan Ouyang Asklepios Klinik St. Georg Hamburg Sept. 19th, 2008, Hangzhou Catheter ablation of atrial fibrillation Successful acute PV isolation rate almost 100% in experienced centers Clinical success rate: variable 50-93 (65)% with multiple procedures ?Recovered“ PV spikes in ~ 95% pts during reprocedures PV severe stenosis/occlusion ~ 1% Effect only on the PV, but not in the PV antrum Cappato et al. Circulation 2003;108:1599–1604 Catheter ablation of atrial fibrillation Procedure endpoints Potential amplitude within the isolated area 0.1 mV No information on PV potentials No information on line completeness Gap-related LAMRT Clinical outcome: not reproducible Atrial fibrillation – Surgery AF ablation with Surgery AF abation with Surgery 13 / 14 Patient: complete PVI FU of 25 ± 11 months: SR in 13 pts Isolated PV-LA Region: spontanenous AF: 4 pts inducible AF: 1 pt The remaining atrium: SR: 13 pts Non-sustained AF: 1 pt PV Antrum Isolation Catheter ablation of AF in experienced center Inducibility of AF after Circumferential PVI Non-inducibility of AF was used as endpoints after AF ablation, but there were some differences in the published studies - definition of sustained AF - ablation techniques - procedure endpoints - induction protocol Catheter Ablation of AF Fragmented mapping and ablation Termination of AFib: 115/121 (95%) pts During one year follow-up: -110 (91%) pts: SR -92 after one ablation -18 after two ablations Improvement of LV-EF after AF ablation Paroxysmal Atrial Fibrillation Balloon techniques Catheter ablation of AF The finding of PV spikes is the cornerstone in catheter ablation of AF Ablation strategy has been changed into circumferential PV isolation for PAF in the majority of centers Maintenance of stable SR can improve left ventricular EF after catheter ablation of AF Long-term FU 5 years is still very limite