持续性心房颤动的导管消融策略.ppt

持续性心房颤动的导管消融策略Ablation Strategy of Persistence Atrial Fibrillation;定义 Definition;房颤的机制与组织学Mechanism and Hitology;持续性房颤的主频标测 Dominant Frequency;持续性房颤目前的主要消融策略;持续性房颤消融：单纯大环肺静脉隔离（PVI）的价值;单中心六年随访结果Six Year Follow-Up After Catheter Ablation of Atrial Fibrillation:A Palliation More Than a True Cure  ----Sorgente A, et al. Am J Cardiol, 2012;109:1179 –1186;持续性房颤消融：碎裂电位（CFAE）消融的价值;PVI+碎裂电位（CFAE）消融随机对照试验 ---- Oral H, et al. J Am Coll Cardiol, 2009 Mar.3;53(9):782-9;STAR AF StudySubstrate and Trigger Ablation for Reduction of Atrial Fibrillation (STAR AF): a randomized, multicentre, international trial ---- Verma A, et al. Eur Heart J, 2010 Jun;31(11):1344-56;持续性房颤消融：线性消融的价值;PVI+顶部/峡部线a prospective randomized comparison ---- Willems S, et al. Eur Heart J, 2006 Dec;27(23):2871-8;PVI+线性 vs PVI+CFAE对比—A Prospective Randomized Study  ---- Estner HL, et al. PACE, Aug 2011; 34(8): 939-48 ;Depicted are success rates after a single ablation procedure for  both groups.(*indicates significant difference);RASTA--不同消融策略的随机对比Randomized Ablation Strategies for the Treatment of Persistent Atrial Fibrillation: RASTA Study ---- Dixit S, et al. Circ Arrhythm Electrophysiol, 2012;Shows long term procedural efficacy in the 3 study arms;单主波大折返理论Dominant Rotor Random Reentry; 持续性心房颤动的线性消融 ----递进式个体化心房基质消融;消融术中iv伊布利特以期转为房扑或窦律后针对性加强消融; 静脉注射1mg伊布利特的转复率;随访结果 对成功率影响无差异;其他因素;球囊冷凝：1，单纯PVI；2，效能不足 目前主要用于阵发房颤;消融中终止房颤对长期效果的影响Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint ---- Mark D, et al. European Heart Journal, (2009) 30, 1105–1112;术前复律对消融效果的影响Improved outcome