Catheter Ablationof Ventricular Tachycardia without 室性心动过速无导管消融.ppt

New targets of AF ablation –CFAE and GPs Helmut Pürerfellner Public Hospital Elisabethinen, Academic Teaching Center Linz, Austria Ablation strategy Focal (within PV) Segmental ostial Circumferential atrial Additional lines Substrate mapping (CAFE, DF) Ganglionated plexus (GP) Lecture outline AF mechanisms Definition of complex fractionated atrial electrograms (CFAE) Mechanisms underlying CFAE Identification of CFAE Automated detection Conclusions Mapping of human AF Atrial electrograms during sustained AF: single/double/complex fractionated potentials Localized to specific sites with remarkable temporal and spatial stability CFAE may represent AF substrate sites and are targets for AF ablation Definition of CFAEs Atrial electrograms that are fractionated and composed of ≥2 deflections ± perturbation of the baseline with continuous deflections from a prolonged activation complex Atrial electrograms with a very short cycle length (≤120ms) ± multiple potentials when compared with atrial cycle length from other parts of the atria Identification of CFAEs Visual inspection: subjective judgement, interobserver variability Automated detection: objective Visual inspection of CFAEs Visual inspection of CFAEs –Variable clinical results Nademanee et al (JACC 2004): 91% success at 1 year (PAF and CAF) Oral et al (Circulation 2007): 57% success at 13 months (only CAF) Verma et al (JCE 2007): 83% success at 13 months (PAF and CAF vs 72% control group PVAI only) Takahashi et al (JACC 2008): 90% success at 14 months (only CAF, combining with PVI and lines) Characterization of Electrograms associated with termination of CAF by catheter ablation Takahashi et al, JACC 2008;51:1003-1010 Characterization of Electrograms associated with termination of CAF by catheter ablation Takahashi et al, JACC 2008;51:1003-1010