心房碎裂电位在房颤消融中的应用PPT.pptVIP

Note: 作为CFAE的发现者Koonlawee Nademanee医师会议上报告了如何确定CFAE及消融CFAE根治房颤的经验，首先在持续房颤时（阵发房颤者反复诱发）标测CFAE分布并标记在CARTO三维模型上，然后在这些部位消融，消融主要终点是CFAE完全消失或转为窦性心律，并且不能被再次诱发，消融过程中会见到心房频率逐渐减慢。如果CFAE完全消失后转为房扑或房速，则进一步标测和消融。手术全程不使用肺静脉环状标测电极导管，不观察肺静脉电位。 Nademanee医师认为CFAE在心房不同部位分布差别很大，但是特定类型的CFAE部位很固定，因此可逐点进行消融，慢性房颤CFAE分布区域较阵发性房颤广。靠术者肉眼确定CFAE并在CARTO三维模型上打标受术者经验影响较大，新近Koonlawee Nademanee医师等已开发出CFAE软件并整合在CARTO三维模型上，根据导管经过局部的心内电图自动确定CFAE并以不同颜色显示其分布。不仅节约标测时间，而且减少对术者的依赖性。但是象CARTO激动顺序标测一样，CFAE标测也需要手工校正，临床应用例数尚少。 OBJECTIVES We sought to test the hypothesis that complex fractionated electrograms (CFAEs) recorded during atrial fibrillation (AF) could be used as target sites for catheter ablation of AF. BACKGROUND Mapping of AF in humans has shown that areas of CFAEs correlate with areas of slowed conduction and pivot points of reentrant wavelets. We hypothesized that such areas of CFAEs could be identified in patients with AF and might serve as target sites for catheter ablation to maintain sinus rhythm. METHODS The study population included 121 patients (29 females; mean age, 63 years) with refractory AF (57 paroxysmal, 64 chronic). All patients underwent nonfluoroscopic electroanatomic mapping (CARTO) during AF. Using CARTO, the biatrial replica, displayed in a three-dimensional color-coded voltage map, was created during AF, and areas associated with CFAEs were identified. Radiofrequency ablation of the area with CFAEs was performed, aiming to eliminate CFAE and/or convert to sinus rhythm. RESULTS Complex fractionated atrial electrograms were found in seven of nine regions of both atria, but were mainly confined to the interatrial septum, pulmonary veins, roof of left atrium, and left posteroseptal mitral annulus and coronary sinus ostium. Ablations of the areas associated with CFAEs resulted in termination of AF without external cardioversion in 115 of the 121 patients (95%); 32 (28%) required concomitant ibutilide treatment. At the one-year follow-up, 110 (91%) patients were free of arrhy