导管消融对房颤治疗模式的影响_董建增.ppt

消融致窦性停搏13秒 消融致房室传导阻滞22秒并出现阿－斯 于右侧上下肺静脉之间消融终止房颤 有起搏除颤装置者导管消融安全有效 71例起搏器，15例 ICD，86例为对照 术前调整为V V I ,关闭快速心律失常的诊断治疗功能 25%出现60s工作异常,无长期的异常存在 2例心房电极移位（安装术6月内） 消融和X-ray时间无差异 成功率无差异 　　　CHADS 2 计分的两面性 CPVA＋CTI PROTECT AF研究：成功植入者的比较 微创外科切除左心耳取代药物抗凝 导管消融减少脑卒中的风险 仿MAZE导管消融术---房颤导管消融的早期“探索” 节段消融肺静脉电隔离 ---使人们对房颤导管消融“信心倍增” CFAE 消融---与PVI完全不同的方法 老年房颤治疗策略的选择---阻断房室结＋起搏 vs. 导管消融 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. 欧洲进行的ANDROMEDA研究，627名心衰患者，90%以上的心功能为NYHAII-III，317名患者分到安慰剂组，310名分到决奈达隆组，400mg,2/日。 试验开始7个月后因药物组的死亡率明显高于安慰剂组而提前停止。死亡的主要原因是决奈达隆组心衰进展的患者明显增多。 Background Dronedarone is a novel antiarrhythmic drug with electrophysiological properties that are similar to those of amiodarone, but it does not contain iodine and thus does not cause iodine-related adverse reactions. Therefore, it may be of value in the treatment of patients with heart failure. Methods In a multicenter study with a double-blind design, we planned to randomly assign 1000 patients who were hospitalized with symptomatic heart failure and severe left ventricular systolic dysfunction to receive 400 mg of dronedarone twice a day or placebo. The primary end point was the composite of death from any cause or hospitalization for heart failure. Results After inclusion o