持续性房颤的消融策略进展课件

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持续性房颤导管消融进展12014AHA/ACC/HRSGuildeline·c|assllaAFcatheterablationisreasonableforselectedpatientswithsymptomaticpersistentAFrefractoryorintoleranttoatleast1classiorIllantiarrhythmicmedication(388,392-394).(Levelofevidence:AClassllb1.AFcatheterablationmaybeconsideredforsymptomaticlong-standing(12months)persistentAFrefractoryorintoleranttoatleast1classiorIllantiarrhythmicmedication,whenarhythmcontrolstrategyisdesired(356,398).(LevelofEvidence:B)2.AFcatheterablationmaybeconsideredpriortoinitiationofantiarrhythmicdrugtherapywithaclassiorlllantiarrhythmicmedicationforsymptomaticpersistentAf,whenarhythmcontrolstrategyisdesired(LevelofEvidence:C)2014AHA/ACC/HRSGuildeline2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PCPVA(ICPVA(+LinealBoxablationCFAECPVHLinear+CEAEN=10N=3N=6·成功率成功率成功率成功率·成功率%37%6~5611%~7444%~524%~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BrookAGetal.HeartRhythm.2010:7:835-846持续性房颤消融——各领风骚3欧洲心律学会持续性房颤消融技术最新调查Currentablationtechniquesforpersistentatrialfibrillation:resultsoftheEuropeanHeartRhythmAssociationSurveyProforrodstrategloratlaonofportent,butnotlong-standngAF叫onlyPVIplusPvuPreferredabaionstratagy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欧洲心律学会持续性房颤消融技术最新调查4激进消融术式的代表—-stepwiseablationpVSVCcsAtrialLinearatonAblatioAblationSitesofrecurrentAT房颤消融终止率84%Conclusion:Catheterablationoflong-lastingpersistentAFassociatedteAFterminationachievesrenceinthemajorityofpatientsisAT.(JCardiovascElectroph1138-1147,November2005)MarkD.ONeill,JIntervCardElectrophysiol(2006)16:153-167激进消融术式的代表—-stepwiseablation5Stepwiseablation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≥44mm1年内复发率100%次消融后总成功率51%OGroup2CHADS?50om23rLAcmansicn44oa1Recurrencerateafterasingleprocedure=71.6%⑤m甲3c"as2v02MLogo-0ocaFollow-up(months)ChenSA,etal.CireArrhythmElectrophysiol.2012:5:514-520Stepwiseablation不是终极术式6激进消融伴随的风险不可轻视CS远端消融波尔多资料Stepwise消融造成疤痕(31%)和低韦位区(32致LCX损伤脏压妻发生率3%%),影响左房机械功能TakahashiY,etal.JAmCollCardial,2007,49:1306-1314WeerasoorivaRJACC2011:57.激进消融伴随的风险不可轻视7Lessismore果项研显示肺静脉隔离基础上附加消融成Dixit,Setal.RandomizedablationstrategiesforthetreatmentofpersistentatrialfibrillationRASTastudyCircArrhythmElectrophysiol2012:5:287-294Vermaa,etal.approachestocatheterablationforpersistentatrialfibrillationNEnglJMed2015;372:1812-22Lessismore8STARAFIITrial(TheSubstrateandTriggerablationReductionofAtrialFibrillationTrialPartll)oCatheterablatforPersistentAtrialFibrillationN=67N=263N=259VermaA,etal.NEnglJMed2015:372:1812-22STARAFIITrial(TheSubstrat9各组基线资料Table1.CharacteristicsofthePatientsatBaseline.aplusElectrogramslusLinesCharacteristicN=259AReEjectionfraction-9655±1157±10eftatrialdiameter44±6Timefromfirstdiagnosisofatrialfibrillation4.3±6.34.2±5.03.6±4.2onstantatrialfibrillationfor>6mo-no.(2)52(8207(79)143(54)2B3)21(8)29(1)StrokeortransentischemicattackHeartfailure各组基线资料10持续性房颤的消融策略进展课件11持续性房颤的消融策略进展课件12持续性房颤的消融策略进展课件13持续性房颤的消融策略进展课件14持续性房颤的消融策略进展课件15持续性房颤的消融策略进展课件16持续性房颤的消融策略进展课件17持续性房颤的消融策略进展课件18持续性房颤的消融策略进展课件19持续性房颤的消融策略进展课件20持续性房颤的消融策略进展课件21持续性房颤的消融策略进展课件22持续性房颤的消融策略进展课件23持续性房颤的消融策略进展课件24持续性房颤的消融策略进展课件25持续性房颤的消融策略进展课件26持续性房颤的消融策略进展课件27持续性房颤的消融策略进展课件28持续性房颤的消融策略进展课件29持续性房颤的消融策略进展课件30持续性房颤的消融策略进展课件31持续性房颤的消融策略进展课件32持续性房颤的消融策略进展课件33持续性房颤的消融策略进展课件34持续性房颤的消融策略进展课件35持续性房颤的消融策略进展课件36持续性房颤的消融策略进展课件37持续性房颤的消融策略进展课件38持续性房颤的消融策略进展课件39持续性房颤的消融策略进展课件40持续性房颤的消融策略进展课件41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持续性房颤导管消融进展422014AHA/ACC/HRSGuildeline·c|assllaAFcatheterablationisreasonableforselectedpatientswithsymptomaticpersistentAFrefractoryorintoleranttoatleast1classiorIllantiarrhythmicmedication(388,392-394).(Levelofevidence:AClassllb1.AFcatheterablationmaybeconsideredforsymptomaticlong-standing(12months)persistentAFrefractoryorintoleranttoatleast1classiorIllantiarrhythmicmedication,whenarhythmcontrolstrategyisdesired(356,398).(LevelofEvidence:B)2.AFcatheterablationmaybeconsideredpriortoinitiationofantiarrhythmicdrugtherapywithaclassiorlllantiarrhythmicmedicationforsymptomaticpersistentAf,whenarhythmcontrolstrategyisdesired(LevelofEvidence:C)2014AHA/ACC/HRSGuildeline43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PCPVA(ICPVA(+LinealBoxablationCFAECPVHLinear+CEAEN=10N=3N=6·成功率成功率成功率成功率·成功率%37%6~5611%~7444%~524%~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BrookAGetal.HeartRhythm.2010:7:835-846持续性房颤消融——各领风骚44欧洲心律学会持续性房颤消融技术最新调查Currentablationtechniquesforpersistentatrialfibrillation:resultsoftheEuropeanHeartRhythmAssociationSurveyProforrodstrategloratlaonofportent,butnotlong-standngAF叫onlyPVIplusPvuPreferredabaionstratagy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欧洲心律学会持续性房颤消融技术最新调查45激进消融术式的代表—-stepwiseablationpVSVCcsAtrialLinearatonAblatioAblationSitesofrecurrentAT房颤消融终止率84%Conclusion:Catheterablationoflong-lastingpersistentAFassociatedteAFterminationachievesrenceinthemajorityofpatientsisAT.(JCardiovascElectroph1138-1147,November2005)MarkD.ONeill,JIntervCardElectrophysiol(2006)16:153-167激进消融术式的代表—-stepwiseablation46Stepwiseablation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≥44mm1年内复发率100%次消融后总成功率51%OGroup2CHADS?50om23rLAcmansicn44oa1Recurrencerateafterasingleprocedure=71.6%⑤m甲3c"as2v02MLogo-0ocaFollow-up(months)ChenSA,etal.CireArrhythmElectrophysiol.2012:5:514-520Stepwiseablation不是终极术式47激进消融伴随的风险不可轻视CS远端消融波尔多资料Stepwise消融造成疤痕(31%)和低韦位区(32致LCX损伤脏压妻发生率3%%),影响左房机械功能TakahashiY,etal.JAmCollCardial,2007,49:1306-1314WeerasoorivaRJACC2011:57.激进消融伴随的风险不可轻视48Lessismore果项研显示肺静脉隔离基础上附加消融成Dixit,Setal.RandomizedablationstrategiesforthetreatmentofpersistentatrialfibrillationRASTastudyCircArrhythmElectrophysiol2012:5:287-294Vermaa,etal.approachestocatheterablationforpersistentatrialfibrillationNEnglJMed2015;372:1812-22Lessismore49STARAFIITrial(TheSubstrateandTriggerablationReductionofAtrialFibrillationTrialPartll)oCatheterablatforPersistentAtrialFibrillationN=67N=263N=259VermaA,etal.NEnglJMed2015:372:1812-22STARAFIITrial(TheSubstrat50各组基线资料Table1.CharacteristicsofthePatientsatBaseline.aplusElectrogramslusLinesCharacteristicN=259AReEjectionfraction-9655±1157±10eftatrialdiameter44±6Timefr