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1、持续性房颤的消融策略进展,1、战鼓一响，法律无声。英国2、任何法律的根本；不，不成文法本身就是讲道理法律，也-即明示道理。爱科克3、法律是最保险的头盔。爱科克4、一个国家如果纲纪不正，其国风一定颓败。塞内加5、法律不能使人人平等，但是在法律面前人人是平等的。波洛克,持续性房颤的消融策略进展持续性房颤的消融策略进展1、战鼓一响，法律无声。英国2、任何法律的根本；不，不成文法本身就是讲道理法律，也-即明示道理。爱科克3、法律是最保险的头盔。爱科克4、一个国家如果纲纪不正，其国风一定颓败。塞内加5、法律不能使人人平等，但是在法律面前人人是平等的。波洛克持续性房颤导管消融进展王新华上海交通大学医学院附
2、属仁济医院心内科2014 AHA/ACC/HRS Guildelinec| ass llaAF catheter ablation is reasonable for selected patients with symptomaticpersistent AF refractory or intolerant to at least 1 class i or Ill antiarrhythmicmedication(388, 392-394). ( Level of evidence: AClass llb1. AF catheter ablation may be considered f
3、or symptomatic long-standing(12 months) persistent AF refractory or intolerant to at least 1 class i or Illantiarrhythmic medication, when a rhythm control strategy is desired (356,398). (Level of Evidence: B)2. AF catheter ablation may be considered prior to initiation ofantiarrhythmic drug therapy
4、 with a class i or lll antiarrhythmic medicationfor symptomatic persistent Af, when a rhythm control strategy is desired(Level of Evidence: C),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 Guildelinec| ass llaAF catheter ablation is reasonable for selected patients with symptomaticpersistent AF
5、refractory or intolerant to at least 1 class i or Ill antiarrhythmicmedication(388, 392-394). ( Level of evidence: AClass llb1. AF catheter ablation may be considered for symptomatic long-standing(12 months) persistent AF refractory or intolerant to at least 1 class i or Illantiarrhythmic medication
6、, when a rhythm control strategy is desired (356,398). (Level of Evidence: B)2. AF catheter ablation may be considered prior to initiation ofantiarrhythmic drug therapy with a class i or lll antiarrhythmic medicationfor symptomatic persistent Af, when a rhythm control strategy is desired(Level of Ev
7、idence: 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PCPVA(ICPVA(+ LinealBox ablationCFAECPVHLinear+CEAEN=10N=3N=6成功率成功率成功率成功率成功率%37%65611%7444%524%6336%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 atrialfibrillation:
8、results of the European Heart RhythmAssociation SurveyProforrod strateg lor atla on of portent, but not long-standng AF叫 only PVI plus PvuPreferred ab aion stratagy主要结论:持续性房颤倾向于P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 ablationpV SVC csAtrialLinearatonAblatioAblationSites of recurre
9、nt AT房颤消融终止率84%Conclusion: Catheter ablation of long-lasting persistent AF associatedte AF termination achievesrence in the majority of patients is AT.(J Cardiovasc Electroph1138-1147, 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
10、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%O Group 2 CHADS? 50om23 r LA cmansicn 44oa1 Recurrence rate after a single procedure=71.6%m甲3cas2v02MLogo-0ocaFollow-up(months)Chen SA, et al. Cire Arrhythm Electrophysiol. 2012: 5: 514-520,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LC
11、X损伤脏压妻发生率3%),影响左房机械功能Takahashi Y, et al. J Am Coll Cardial, 2007, 49: 1306-1314Weerasooriva R JACC 2011: 57.,Less is more果项研显示肺静脉隔离基础上附加消融成Dixit, S et al. Randomized ablation strategies for thetreatment of persistent atrial fibrillation RASTa studyCirc Arrhythm Electrophysiol 2012: 5: 287-294Verma a
12、, et al. approaches to catheter ablation forpersistent atrial fibrillationN Engl J Med2015;372:1812-22,STAR AF II Trial (The Substrate and Trigger ablationReduction of Atrial Fibrillation Trial Part ll)o Catheter ablatfor Persistent Atrial FibrillationN=67N=263N=259Verma A, et al. N Engl J Med 2015:
13、 372: 1812-22,各组基线资料Table 1. Characteristics ofthe Patients at Baseline.aplus Electrogramslus LinesCharacteristicN=259AReEjection fraction-9655115710eft atrial diameter446Time from first diagnosis of atrial fibrillation4.36.34.25.03.64.2onstant atrial fibrillation for 6 mo-no. (2)52(8207(79)143(54)2B3)21(8)29(1)Stroke or trans ent ischemic attackHeart failure,51、天下之事常成于困约，而败于奢靡。陆游52、生命不等于是呼吸，生命是活动。卢梭53、伟大的事业，需要决心，能力，组织和责任感。易卜生54、唯书籍不朽。乔特55、为中华之崛起而读书。周恩来,谢谢！,
