房颤的基质识别及价值演示文稿.pptVIP

长时间持续性房颤：CPVI+CFAE≯CPVI Conclusions: up to 2 h of additional ablation of CFAEs after APVI does not appear to improve clinical outcomes in patients with long-lasting persistent AF. 119例CAF，CPVI 100例AF 复律，50例 CFAE ABL，50例 9例SR 19例SR 15/19（79％） 17/50（34％） 18/50（36％） Oral H, et al. J Am Coll Cardiol, 2009;53(9):782-9 现在是31页\一共有64页\编辑于星期四 Natale, et al.Heart rhythm,2008 现在是32页\一共有64页\编辑于星期四 RASTA Study Randomized Controlled Trial 1 year Follow-up Evaluate the single procedure efficacy of Per-AF Per-AF (n=156) Group2 (n=50) Group3 (n=51) Group1 (n=55) PVI PVI+Lines PVI+CFE 现在是33页\一共有64页\编辑于星期四 PVI PVI+Lines PVI+CFE *P=0.04 *P=0.004 RASTA Study Primary Study End Point: Freedom from AF/AT off AADs 29%??? 现在是34页\一共有64页\编辑于星期四 现在是35页\一共有64页\编辑于星期四 碎裂电位的本质 真正的“房颤巢”－－AF substrate 心肌纤维排列紊乱或纤维化区域的各向异性传导及缓慢传导－－肺静脉前庭、后壁 心肌排列重叠区域－－间隔、冠状窦 现在是36页\一共有64页\编辑于星期四 代表房颤基质的碎裂电位 低振幅的碎裂电位 单极记录持续负向的碎裂电位 比较固定的碎裂电位 现在是37页\一共有64页\编辑于星期四 Comparison of Left Atrial Electrophysiologic Abnormalities during Sinus Rhythm in Patients with Paroxysmal, Persistent and Long-Standing Atrial Fibrillation Par-AF: 30 pts Per-AF: 22 pts LS-AF: 28 pts Control: 20 pts with LAP 现在是38页\一共有64页\编辑于星期四 Mapping Methods A-Focus high density mapping during sinus rhythm Mapping was done after CPVI, Per-AF and LS-AF need cardioversion NavX: interior and exterior projection, interpolaration were set at 5 mm LA voltage, activation time and complex electrograms were analyzed 现在是39页\一共有64页\编辑于星期四 现在是40页\一共有64页\编辑于星期四 现在是41页\一共有64页\编辑于星期四 现在是42页\一共有64页\编辑于星期四 Comparison of the LA activation time among different populations 现在是43页\一共有64页\编辑于星期四 The correlation of LA activation time with overall mean bipolar voltage, left atrium diameter，low voltage index and percentage of complex electrograms 现在是44页\一共有64页\编辑于星期四 Definition of Complex Electrocardiogram Distinct deflections ≥ 3 Electrocardiogram duration≥ 50 ms > 50ms 现在是45页\一共有64页\编辑于星期四 A: Comparison of the