持续性房颤的消融策略进展ppt课件.pptxVIP

111持续性房颤导管消融进展

2222014AHA/ACC/HRSGuildelineClassIIaAFcatheterablationisreasonableforselectedpatientswithsymptomaticpersistentAFrefractoryorintoleranttoatleast1classIorIIIantiarrhythmicmedication(388,392-394).(LevelofEvidence:A)ClassIIb1.AFcatheterablationmaybeconsideredforsymptomaticlong-standing(12months)persistentAFrefractoryorintoleranttoatleast1classIorIIIantiarrhythmicmedication,whenarhythmcontrolstrategyisdesired(356,398).(LevelofEvidence:B)2.AFcatheterablationmaybeconsideredpriortoinitiationofantiarrhythmicdrugtherapywithaclassIorIIIantiarrhythmicmedicationforsymptomaticpersistentAF,whenarhythmcontrolstrategyisdesired.(LevelofEvidence:C)

333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PVIN＝4成功率20％CPVA(I)N＝4成功率37％～56％CPVA(I)+LinearN＝10成功率11％～74％BoxablationN=3成功率44％～50％CFAEN=5成功率24％～63％CPVI+Linear＋CFAEN=6成功率36％～68％BrookAGetal.HeartRhythm.2010;7:835-846消融术式繁杂同一术式结果差异性大无法评价孰优孰劣

444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必威体育精装版调查

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激进消融术式的代表——stepwiseablationMarkD.O’Neill,JIntervCardElectrophysiol(2006)16:153–167

666ChenSA,etal.CircArrhythmElectrophysiol.2012;5:514-520.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％CHADS2积分≥3或者左房内径≥44mm1年内复发率100％三次消融后总成功率51％Stepwiseablation不是终极术式

777Takahashi.JCardiovascElectropysiol,2005,16:1104TakahashiY,etal.JAmCollCardiol,2007,49:1306–1314WeerasoorivaR.JACC2011;57:160激进消融伴随的风险不可轻视

888Lessismore？近期几项研究显示肺静脉隔离基础上附加消融并不能增加成功率Dixit,S.etal.Randomizedablationstrategiesforthetreatmentofpersistentatrialfibrillation:RASTAstudy.CircArrhythmElectrophysiol2012;5:287–294VermaA,etal.Approachestocatheterablationforpersistentatrialfibrillation.NEnglJMed2015;372:1812-22……

999STARAFIITrial(TheSubstrateandTriggerAblationReductionofAtrialFibrillationTrialPartII)VermaA,etal.NEnglJM