房颤的外科治疗课件.ppt

* * * * * * * * * * * * * * * * * * * * * * * * Van Gogh Surgical Treatment of Atrial Fibrillation Thomas Kuntze Zentralklinik Bad Berka, Germany Prevalence of atrial fibrillation End of “food chain” Treatment of atrial fibrillation Stepwise approach ? Medication ? Cardioversion (+ Medication) ? Interventional catheter ablation Cardiac surgeon Surgical treatment of atrial fibrillation ? Indications ? Techniques ? Results HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up Symptomatic AF patients undergoing other  cardiac surgical procedures, ? 2007 Heart Rhythm Society. 2. Selected asymptomatic AF patients undergoing cardiac surgery in whom the ablation can be performed with minimal risk, 3. Stand-alone AF surgery should be considered for symptomatic AF patients who prefer a surgical approach, have failed one or more attempts at catheter ablation, or are not candidates for catheter ablation. Elimination of all hypothetic biatrial reentry circuits Cut-and-sew technique: Biatrial linear lesions + LA/RA mass reduction + PV-Isolation) J. Cox et al. J Thorac Cardiovasc Surg 1991; 101: 406-426 Surgery for Atrial Fibrillation:Maze Procedure Extensive lesion set Technically challenging Requires CPB and cardioplegic arrest Adds 30-60 minutes to crossclamp time Morbidity of pacemaker implantation LA dysfunction excellent results not reproducible High cure rate (90%) Long-term efficacy is proven Applicable to both chronic and paroxysmal Shortcomings Advantages Pathophysiology of Atrial Fibrillation Focal Triggers Substrate/ Maintenance, Macro-Reentry circuits Paroxysmal Persistant Permanent Importance Natural History The rationale for the surgical treatment of AF ablation consists of two approaches: Circumferential left atrial PV ablation for thetreatment of paroxysmal AF or Circumferential left atrial PV ablation plus substratemodification for the treat