心房颤动与充血性心力衰竭：房室结消融加起搏治疗的地位.pptVIP

Atrial Fibrillation and Congestive Heart Failure: Role of AVN Ablation and Pacing “Two new epidemics of cardiovascular disease are emerging: Heart failureand atrial fibrillation.” Objectives AF and CHF, a vicious cycle Clinical outcomes following AVN ablation and pacing Symptoms, functional capability Survival Evolving pacing methods in AF and CHF Questions and challenges Atrial Fibrillation and CHF AF–Adverse Effect of Irregular Rate Atrial FibrillationAdverse Effect of Irregular Rate Possible mechanisms Shortened diastolic filling time Short RR intervals have negative inotropic effect Short RR intervals ? CO more than long RR intervals improve CO Ejection Fraction After AVN Ablation63 Pts with EF 45% at Baseline Ejection Fraction and AVN Ablation AFib and CHF – Temporal Relations and MortalityFramingham Study Diastolic Dysfunction and Developmentof NRAF Atrial Fibrillation and Heart FailureArrhythmogenic Substrate Initiation and Trigger Neuro-humoral fluctuation Bradycardia Tachycardia Stretch APCs, PV, SVC Ischemia Atrial Fibrillation and CHF Radiofrequency Ablation ofAV Junction Long Term Survival Following AVN Ablation Pts (No CHF, MI, or Cardiac Drugs) vs Normal Population Long Term Survival Following AVN Ablation EF 40% vs Normal Population Long Term Survival Following AVN ablationNear Normalization of EF vs Normal Population Role of Cardiac Resynchronization in Patients with CHF and RV PacingIs Iatrogenic LBBB Analgous to Spontaneous LBBB? 20 patients with chronic AF and CHF Prior AVN RF and RV apical pacing EF 22 % LVEDd 68 mm LV pacing lead added and “Y” adapted to VVIR pulse generator Effects of BiV Pacing on Functional Status and EF in RV Paced Patients After AVN Ablation PAVE Study Design Prevention of Atrial Fibrillation Atrial Fibrillation–Management CP1096645-23 AFFIRM: Adverse Events Event No. % No. % No. % P Primary endpoint (death) 666 26.3 310 25.9 356 26.7 0.08 Secondary endpoint 861 32.3 416 32.7 44