房颤导管消融治疗指南解读马骥ppt课件.pptVIP

房颤导管消融治疗指南解读;房颤的分类;Catheter ablation is a reasonable alternative to pharmacological therapy to prevent recurrent AF in symptomatic patients with little or no LA enlargement. --（IIA recommendation）--ACC/AHA/ESC房颤指南2006 The Task Force supports these recommendations. In particular, the Task Force agrees that catheter ablation of AF in general should NOT be considered as first line therapy. -- HRS/EHRA/ECAS 房颤消融专家共识2007;关于房颤导管消融治疗适应证的几个问题？;NEJM, 2006,354:934;Hsu . NEJM. 2004: 2372 ;2008-10-23;81例心衰房颤;房颤导管消融治疗适应证选择的现实建议;房颤可能的电生理机制;房颤导管消融的主要策略;不同房颤导管消融技术的消融终点;Right PV antrum;环肺静脉前庭消融/隔离;关于复杂碎裂心房电位的定义(Complex Fractionated Atrial Electrograms,CFAEs); CFAE 常见分布部位;MR Angiogram - PA Projection;消融术中的房颤终止模式;Step 1: PV isolation Step 2: Roof ablation Step 3: Electrogram-based ablation Step 4: MI ablation ( and lateral LA);慢性房颤消融的Haissaguerre术式：真正的导管迷宫？;635 pts, 60% non-paroxysmal AF CFAE ablation only, F/U=836±605 days CFAE-targeted ablation of AF is effective in maintaining SR(81.4%) in selected high-risk AF patients and might allow patients(84%) to stop warfarin therapy SR after AF ablation is a marker of relatively low mortality and stroke risk;房颤消融的策略和终点建议;房颤导管消融围术期抗凝(HRS/EHRA/ECAS 房颤消融专家共识);房颤导管消融术前抗凝 (HRS/EHRA/ECAS 房颤消融专家共识);房颤导管术中抗凝 (HRS/EHRA/ECAS 房颤消融专家共识);拔管后4-6小时开始静脉应用肝素或皮下依诺肝素抗凝，同时合并应用华法林直至INR达标后停用 应用0.5mg/kg依诺肝素日两次 术后所有的患者均应服用华法林至少两个月 对于CHADS评分≥2分的患者术后无论是否为窦性心律均不应停用华法林 对于CHADS评分为1 分的患者可应用华法林或阿司匹林 ;房颤导管消融术的相关抗凝—威尼斯共识;早期复发患者的再次消融时机;房颤导管消融并发症;房颤消融的主要并发症发生率;谢谢！