心衰合并房颤患者的射频消融治疗 201506.pptVIP

年龄 小于75岁; 心脏无显著扩大，特别是左房应小于60mm; 心功能II-III级； 房颤在先，心衰在后优先； 持续性房颤伴心衰患者电复律无效； 已经植入CRT患者，房颤影响疗效，考虑维持窦律患者。 哪些房颤合并心衰患者适合进行射频消融？ 房颤无心衰患者 阵发性--------------- 持续性------------ 长程持续性 --------------- 阵发性--------------- 持续性------------ 长程持续性 肺静脉触发 非肺静脉触发和左心耳 肺静脉触发 非肺静脉触发和左心耳 房颤伴或不伴心衰发生及维持机制有所不同 房颤合并心衰患者 Aagaard P. Ablation?of?atrial?arrhythmias?in?heart failure. Heart. Fail Clin 房颤合并心衰消融方式推荐 J Am Coll Cardiol. 2014;64(7):710-21 线性消融：众多的线性消融有利于提高持续性房颤消融远期成功率。 CFAEs消融 尽管单纯CFAEs消融根治房颤也有较高的成功率；但目前大多数中心仍将CFAEs消融作为房颤消融的补充术式。 “ ” Framingham Heart Study. 左. Unadjusted cumulative incidence of first CHF in individuals with AF. 右. Unadjusted cumulative incidence of first AF in individuals with CHF. * Framingham Heart Study Impact of Developing the Comorbid Condition on Mortality We used multivariable models to evaluate the impact of CHF on mortality in AF subjects, restricting our analyses to those who were free of CHF at the time of AF diagnosis (Table 2). The subsequent development of CHF (time-dependent variable) was associated with a multivariable-adjusted hazard ratio for mortality of 2.7 (95% CI, 1.9 to 3.7) in men and 3.1 (95% CI, 2.2 to 4.2) in women. Similarly, we examined the impact of AF on mortality in CHF subjects, restricting our analyses to those who were free of AF at the time of CHF diagnosis (Table 2). The development of subsequent AF (time-dependent variable) was associated with an adjusted hazard ratio for mortality of 1.6 (95% CI, 1.2 to 2.1) in men and 2.7 (95% CI, 2.0 to 3.6) in women. HFSIS 以色列心衰住院患者房颤及对预后影响的研究 Aims Atrial fibrillation (AF) and heart failure (HF) commonly coexist, and each adversely affects the other. The aim of the study was to prospectively evaluate the impact of AF and its subtypes on management, and early and long-term outcome of hospitalized HF patients. Methods and results Data were prospectively collected on HF patients hospitalized in all public hospitals in Israel as part of a national survey (HFSIS). Atrial fibrillation patients w