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1、Catheter Ablation of Atrial Fibrillation in the Last 10 Years:Breakthroughs and Advances,Dr.Feifan OuyangAsklepios Klinik St.GeorgHamburgSept.19th,2008,Hangzhou,Haissaguerre et al.NEJM 1998,339:659-666,Haissaguerre et al.NEJM 1998,339:659-666,Haissaguerre et al.NEJM 1998,339:659-666,Success:62%with
2、a median FU of 86 M,Haissaguerre et al.Circulation 2000;102:2463-2465,Haissaguerre et al.Circulation 2000;102:2463-2465,Recurrence in 31 out of 70 pts(44%)-Reablation in 29 of these 31 pts-Freedom of AF:73%at a median of FU of 45 MNo PV stenosis！,162 PVs(no RIPV)in 70 Pts-one breakthrough in 34 PV-t
3、wo breakthroughs in 77 PVs-two breakthrough in 51PVs,Catheter ablation of atrial fibrillation,Successful acute PV isolation rate almost 100%in experienced centers Clinical success rate:variable 50-93(65)%with multiple proceduresRecovered“PV spikes in 95%pts during reproceduresPV severe stenosis/occl
4、usion 1%Effect only on the PV,but not in the PV antrum,Segmental PV isolation,Cappato et al.Circulation 2003;108:15991604,Ernst et al.Circulation 1999;100:2085,13 pts,32 pts,Ernst et al.Circulation 1999;100:2085,No SR,SR in 2/32 pts,Schmidt et al.JCE 2006;17:957964,2000,2004,1999,2001,Pappone C et a
5、l.Circulation 1999,2000,2001,and 2004,Focal?,Small circle within PVs,1.6 cm,1.94 cm,1.74 cm,Pappone et al Circulation 2001,Validation of ablation area:Voltage mapping 0.1 mV,Pappone:PV Encircling“,Oral et al,Circulation 2003;108,Karch et al,Circulation 2005;110,Karch et al Circulation 2005;110,Oral
6、et al Circulation 2003;108,Oral et al,Circulation 2003;108,Karch et al,Circulation 2005;110,Segmental PVI vs Circumferential PV Ablation,Circumferential PV ablation,Catheter ablation of atrial fibrillation,Procedure endpointsPotential amplitude within the isolated area 0.1 mV No information on PV po
7、tentialsNo information on line completenessGap-related LAMRT Clinical outcome:not reproducible,Atrial fibrillation Surgery,Todd et al,Circulation 2003;108,AF ablation with Surgery,Todd et al,Circulation 2003;108,AF abation with Surgery,13/14 Patient:complete PVIFU of 25 11 months:SR in 13 ptsIsolate
8、d PV-LA Region:spontanenous AF:4 ptsinducible AF:1 ptThe remaining atrium:SR:13 ptsNon-sustained AF:1 pt,Todd et al,Circulation 2003;108,Simultaneous isolation of ipsilateral PV in 95%,PV Antrum Isolation,Cleveland Group.HR 2005,Successful rate 90%,Catheter ablation of AF in experienced center,Verma
9、 A 112:12141231,Arentz T et al.Circulation 2007,Arentz T et al.Circulation 2007,Arentz T et al.Circulation 2007,Jais et al.JCE 2005,Oral et al.Circulation 2004,Inducibility of AF on clinical outcome after PVI,Satomi K,.,Ouyang F.Europace 2008,Satomi K et al.Europace 2008,Inducibility of AF after Cir
10、cumferential PVI,Non-inducibility of AF was used as endpoints after AF ablation,but there were some differences in the published studies-definition of sustained AF-ablation techniques-procedure endpoints-induction protocol,Location of fragmented potentials,Nadamanee et al,JACC 2004;43:20442053,Cathe
11、ter Ablation of AF,Fragmented mapping and ablation Termination of AFib:115/121(95%)ptsDuring one year follow-up:-110(91%)pts:SR-92 after one ablation-18 after two ablations,Nadamanee et al,JACC 2004;43:20442053,Ablation of fragmented potentials,Wanzi et al.JAMA 2005,Wanzi et al.JAMA 2005,Study time:
12、12/1/2001-7/1/2002,Wanzi et al.JAMA 2005,1.A small group of Pts2.High success with segmental PVI?,Improvement of LV-EF after AF ablation,Hsu et al.NEJM 2004;351:2372,Nademanee K,et al.JACC 2008;51:843-9,COMPLICATIONS-World Wide Survey,Cappato et al.Circulation 2005;111;1100-1105,Catheter ablation of
13、 atrial fibrillation,%,n=,Paroxysmal Atrial Fibrillation,Verma A 112:12141231,Total 2.9%,Balloon techniques,Steerable HIFU balloonDiameter:20,25,30 mm,SteerableCryo-balloon23,28 mm,The finding of PV spikes is the cornerstone in catheter ablation of AFAblation strategy has been changed into circumfer
14、ential PV isolation for PAF in the majority of centersMaintenance of stable SR can improve left ventricular EF after catheter ablation of AF Long-term FU 5 years is still very limited except surgical approachImproved mortality and reduced stroke is still to be investigate,Conclusions,Catheter ablation of AF,
