持续性房颤颤消融策略进展.pptVIP

持续性房颤导管消融进展 王新华 上海交通大学医学院附属仁济医院心内科  2014 AHA/ACC/HRS Guildeline ·c| ass lla AF catheter ablation is reasonable for selected patients with symptomatic persistent AF refractory or intolerant to at least 1 class i or Ill antiarrhythmic medication(388, 392-394). ( Level of evidence: A Class llb 1. AF catheter ablation may be considered for symptomatic long-standing (12 months) persistent AF refractory or intolerant to at least 1 class i or Ill antiarrhythmic medication, when a rhythm control strategy is desired (356, 398). (Level of Evidence: B) 2. AF catheter ablation may be considered prior to initiation of antiarrhythmic drug therapy with a class i or lll antiarrhythmic medication for symptomatic persistent Af, when a rhythm control strategy is desired (Level of Evidence: C)  持续性房颤消融——各领风骚 32项LPAF消融荟萃分析(累计成功率) 单纯P CPVA(I CPVA(+ Lineal Box ablation CFAE CPVHLinear+ CEAE N=10 N=3 N=6 ·成功率 成功率 成功率 成功率 ·成功率 % 37%6~56 11%~74 44%~5 24%~63·36%~68 % % 消融术式繁杂 同一术式结果差异性大 无法评价孰优孰劣 Brook AG et al. Heart Rhythm. 2010: 7: 835-846  欧洲心律学会持续性房颤消融技术最新调查 Current ablation techniques for persistent atrial fibrillation: results of the European Heart Rhythm Association Survey Proforrod strateg lor atla on of portent, but not long-standng AF 叫 only PVI plus Pv u Preferred ab aion stratagy 主要结论:持续性房颤倾向于PⅥ作为首次消融术式。附加消融步骤和消融终点 不统一反映了最优消融术式的不确定性  激进消融术式的代表— -stepwise ablation pV SVC cs Atrial Linear aton Ablatio Ablation Sites of recurrent AT 房颤消融终止率84% Conclusion: Catheter ablation of long-lasting persistent AF associated te AF termination achieves rence in the majority of patients is AT.(J Cardiovasc Electroph 1138-1147, November 2005) Mark D. ONeill, J Interv Card Electrophysiol(2006)16: 153-167  Stepwise ablation不是终极术式 消融术式:序贯消融 单次消融3年随访结果:房颤房速复发率71.6% CHAD2积分23或者左房内径≥44mm 1年内复发率100% 次消融后总成功率51% O Group 2 CHADS? 50om23 r LA cmansicn 44 oa1 Recurrence rate after a single procedure=71.6% ⑤m甲3cas2v02M Log o-0oca