房颤消融术后房性心律失常的处理和二次消融选择

1、会计学1房颤消融术后房性心律失常的处理和二房颤消融术后房性心律失常的处理和二次消融选择次消融选择背景背景 BackgroundBackground1, Gerstenfeld EP, Heart Rhythm 2007; 4: S65-72个体化递进式线性消融术个体化递进式线性消融术Stepwise Linear Ablation ApproachStepwise Linear Ablation Approach病例数 Patients (n)8080性别 Gender: 男性(M)/女性(F)60/2060/20年龄 Age(岁，years)57579 9房颤持续时间 Duration of

2、 AF (年,years)7 74 4阵发性 Paroxysmal/持续性房颤 Persistent AF62/1862/18左房内径 LA diameter (mm)38388 8左室射血分数 LVEF (%)52526 6器质性心脏病 Structral Heart Disease16 (20%)16 (20%)既往抗心律失常药物 AADs（n)2 21 1LAFLLAFL患者基本特点患者基本特点 Basic Characteristics of LAFL PatientsBasic Characteristics of LAFL Patients结果结果 ResultsResultsCa

3、se 1Case 1： 绕绕MVAMVA的折返的折返 Reentrant around the MVAReentrant around the MVA消融嵴部时消融嵴部时AFAF转为转为LA AFLLA AFL V1CS7.85678910111213141516180msLead IISOCHRONES绕二尖瓣环的折返绕二尖瓣环的折返(Isochronal map of the MVA circuit)(Isochronal map of the MVA circuit)1.等时图显示为绕MVA的顺钟向折返；2.沿MVA激动时间占心动过速周长的100；3.折返环路上全程虚拟单极电图呈rS型且

4、首尾相接；经经MVAMVALIPVLIPV峡部的峡部的“缝隙缝隙”The gap on MVA-LIPV isthmusThe gap on MVA-LIPV isthmus在峡部缝隙处消融转为窦律在峡部缝隙处消融转为窦律 Termination of the LAFLTermination of the LAFLCase2：7字型消融终止房颤后CS S1S1 320bpm诱发LAFLLAFL induced after termination of AF with figure “7” lesionsCase2Case2：经：经LAA-LSPVLAA-LSPV间嵴部缝隙的折返间嵴部缝隙的折返

5、 Reentrant through the gap at LAA-LSPV ridgeReentrant through the gap at LAA-LSPV ridge左房房扑的动态等电位图左房房扑的动态等电位图在嵴部消融终止了在嵴部消融终止了LAFLLAFLLAFL terminated during ablation at the LAA-LSPV ridgeLAFL terminated during ablation at the LAA-LSPV ridgeCase 3: Case 3: 经左房顶部缝隙折返的经左房顶部缝隙折返的LAFL LAFL Reentrant thoug

6、h the gap on the LA roofReentrant though the gap on the LA roof左房房扑的动态等电位图左房房扑的动态等电位图等时图等时图 Isochronal MapIsochronal Map在顶部缝隙处消融终止了在顶部缝隙处消融终止了LAFLLAFLLAFL termination during ablation on the gapLAFL termination during ablation on the gap与左房房扑折返环相关的缝隙分布与左房房扑折返环相关的缝隙分布The distribution of the LAFL relat

7、ed gapsThe distribution of the LAFL related gapsLAA-LSPV LAA-LSPV 嵴部嵴部 （LAA-LSPV rigdeLAA-LSPV rigde） 68 (47%)68 (47%)二尖瓣环峡部二尖瓣环峡部 （MVA isthmusMVA isthmus） 24 (17%)24 (17%)左房顶部左房顶部（LA roofLA roof） 50 (36%)50 (36%)7 7字消融线的多个缝隙字消融线的多个缝隙Multiple Gaps on the Figure Multiple Gaps on the Figure “7 7” lesi

8、on linelesion line顶部的缝隙顶部的缝隙 Gap on LA RoofGap on LA Roof嵴部的缝隙嵴部的缝隙 Gap at LAA-LSPV RidgeGap at LAA-LSPV RidgeMVAMVA的缝隙的缝隙 Gap at LIPV-MVA IsthmusGap at LIPV-MVA Isthmus最终消融成功部位最终消融成功部位 Final TargetFinal Target消融效果消融效果 Ablation ResultsAblation Results随访随访 Follow upFollow up姚焰 中华心律失常学杂志, 2004; 8;356T

9、he formation of the gaps on the lesions lineThe formation of the gaps on the lesions line1.Cabrera JA, Eur Heart J.2008;29:356-62.2. Deisenhofer I, Europace 2006;8:573-82. 3. Mesas CE, JACC 2004;44:1071-9.Cabrera JA, et al. Eur Heart J.2008;29:356-62.D并发症并发症 或或 消融成功的过渡阶段？消融成功的过渡阶段？Complication or Tr

10、ansform to the Success of AF ablationComplication or Transform to the Success of AF ablation？1, Yao Y, Heart Rhythm 20072, Bortone A, JCE 2008 19: 338-341总总 结结 ConclusionsConclusionsCase 1Case 1： 绕绕MVAMVA的折返的折返 Reentrant around the MVAReentrant around the MVA消融嵴部时消融嵴部时AFAF转为转为LA AFLLA AFL 经经MVAMVALIPVLIPV峡部的峡部的“缝隙缝隙”The gap on MVA-LIPV isthmusThe gap on MVA-LIPV isthmusCase2：7字型消融终止房颤后CS S1S1 320bpm诱发LAFLLAFL induced after termination of AF with figure “7” lesions与左房房扑折返环相关的缝隙分布与左房房扑折返环相关的缝隙分布The distribution of the LAFL related gapsThe distribution of the LAFL relat