冷冻球囊消融房颤标准化流程 PPT.pptVIP

ACT激活凝血实验（激活全血凝血时间），是监护体外循环肝素用量的较好的指标之一，正常值60s到130s. * * ACEI[=angiotensin-converting enzyme inhibitor]血管紧张素转化酶抑制剂 ARB:adrenergic receptor binder]肾上腺素能受体结合剂 40-49kg 0.4ml\ 50-59kg 0.5ml\ 60-69kg 0.6ml\ 70-79kg 0.7ml\ 80-89kg 0.8ml\ 90-99kg 0.9ml\ ≥100kg 1.0ml\ 非瓣膜性房颤脑卒中危险因素 * 整个随访期间每周以及有症状时进行电话心电图的监测，90天空白期后3个月，6个月，12个月，之后每6个月都到门诊进行24h心电图检查，9个月及每年两次的电话随访。6个月、12个月，之后每半年一次都会有生活质量评分问卷调查。最长随访时间是33个月。 * * 安全性终点：对于有经验的术者来说，两种消融方法都只有较低的并发症发生率。膈神经麻痹仅见于冷冻球囊组，共10人发生，发生率为2.7%，但是其中8个人在3个月时恢复，1个人在6个月时恢复，只有1例患者12个月时仍然存在膈神经麻痹。射频消融组：腹股沟穿刺部位并发症、心包填塞、消融术后房扑房速发生率都高于冷冻球囊。 * 冷冻球囊组标准差更小，说明离散度更小，所有术者应用冷冻球囊进行PVI左房停留时间和手术时间更一致 * * * 自2012年HRS专家共识就已经声明指出：逐点射频消融能量与冷冻球囊 消融已成为房颤导管消融的两个标准消融系统……就已经肯定了冷冻消融治疗房颤的地位 由于导管消融治疗房颤不管从成功率还是并发症上都明显优于药物治疗，2014年AHA/ACC/HRS指南将导管消融治疗药物不敏感有症状的阵发性房颤作为了IA类推荐 * * Key messages to deliver: Beginning at approximately 32°C (mild hypothermia), the cell and organelle membranes of the cardiomyocytes begin to undergo the first transition, a decrease in fluidity. As the membranes become less fluid, their ion pumps lose transport capability, which is observable electrophysiologically. It is important to note that if held long enough at 0C hypothermic temperatures cells may die. Hypothermic Site Testing Applications: Safety site testing Confirm ablation at a particular site will not affect an undesired target (AV node) Efficacy site testing Confirm targeted substrate (accessory pathway) will be successfully ablated * References: Parvez, B. “Comparison of Lesion Sizes Produced by Cryoablation and Open Irrigation Radiofrequency Ablation Catheters.” J Cardiovasc Electrophysiol Vol. 19, pp. 528-534, May 2008. Wood, M. “Determinants of Lesion Sizes and Tissue Temperatures During Catheter Cryoablation.” PACE 2007; 30:644–654 * Here are the system components walk through each one Note that the ECG cable is not used with the Arctic Front System; however, as you will see later in the slides, it is utilized with the Freezor MAX catheter. Remember that the ball