成像和房颤的新导管消融技术李劲宏课件

Clinical Application of 3DRA Imaging and new Catheter-Technique for Afib Ablation J.H.G.- Li, Min Tang, E.Fleck Peking , 11-13.09.2009 German Heart Institute,Berlin,Germany (DHZB) www.dhzb.de,Atrial Fibrillation,AF Prevalence ( 1 ),AF is the most commen arrhythmia“,* EU 2001, US 2006, jeweils zitiert in Leitlinien 2006 1. Go AS et al. JAMA 2005 2. Fuster V et al. J Am Coll Cardiol 2006,4,5 millions,2,3 millions,0,1,2,3,4,5,USA,EU,AF : - 1 in 25 adults 60 years1 - 1 in 10 adults 80 years1 6,8 millions Patients with AF in EU and USA*1,2,Atrial Fibrillation,Go AS et al. JAMA 2001;285:2370-2375,0,1,0,2,0,4,0,9,1,0,1,7,1,7,3,0,3,4,5,0,5,0,7,3,7,2,10,3,9,1,11,1,0,2,4,6,8,10,12, 55,55-59,60-64,65-69,70-74,75-79,80-84, 85,Age, y,Prevalence %,Prevalence of Diagnosed AF stratified by Age and Sex ( ATRIA-Trial),Men,Women,AF Prevalence ( 2 ),Atrial Fibrillation,Projected Number of Adults With AF in the United States Between 1995 and 2050,Upper and lower curves represent the upper and lower scenarios based on sensitivity analyses,Adults With Atrial Fibrillation, in millions),Year,2050,2045,2040,2035,2030,2025,2020,2015,2010,2005,2000,1995,1990,0,0,1,0,2,0,3,0,4,0,5,0,6,0,7,0,Go AS et al. JAMA 2001;285:2370-2375,2,08,2,44,2,26,2,66,2,94,3,33,3,80,4,34,4,78,5,16,5,42,5,61,AF Prevalence ( 3 ),Atrial Fibrillation,Haissaguerre M ,et al N Engl J Med 1998, focal AF“,Atrial Fibrillation,Conventional Ablation Strategy for AF,CartoMerge NavX with CT-Image CPVA + ,Atrial Fibrillation,Highly effective and fast PVAC,AblationFrontiers) Energie: Cryo-ablation high focussed ultrasound (HIFU) laser,New technologies in AF Ablation (Germany),Atrial Fibrillation,Mapping and Navigation: Real-Time Imaging Using CT-Fluoroscopy Overlay 3DRA ( Philips EPre-Navigator , Siemens, GE ) Stereotaxis ,Sensei Robotic Catheter System,Atrial Fibrillation,3DRA ( German Heart Institute Berlin ),Metherd: - Adenosine (30-40 mg) i.v. asystole & av-block - Rapid ventricular Pacing, Key point: Atrium Low-output,3DRA,from RAO 55 to LAO 55,from RAO 110to LAO 110,Rotationalangiography (3DRA),Atrial Fibrillation,German Heart Institute Berlin,Atrial Fibrillation,CONCLUSION: Intra-procedural contrast-enhanced rotational angiography of the LA-PV during adenosine-induced asystole is feasible and provides anatomical information of high diagnostic value for atrial fibrillation ablation.,Atrial Fibrillation,Atrial Fibrillation,arterial pressure and ECG monitor display,LA-3DRA ( by adenosine ),DHZB (with Allura xper FD 10; Philips Medical System,Best,the Netherlands),J.H. G.-Li, M.Tang, German Heart Institute Berlin,Atrial Fibrillation,LA-3DRA vs. CT,DHZB (with Allura xper FD 10; Philips Medical System,Best,the Netherlands),Atrial Fibrillation,Kriatselis C, Tang M, et al. Heart Rhythm 2009,Atrial Fibrillation,3DRA by rapid ventricular Pacing,No. of patients: 41,Atrial Fibrillation,arterial pressure and ECG monitor display,LA-3DRA ( by RVP ),DHZB (with Allura xper FD 10; Philips Medical System,Best,the Netherlands),J.H. G.-Li, M.Tang, JICE 2009,Atrial Fibrillation,LA-3DRA vs. CT,DHZB (with Allura xper FD 10; Philips Medical System,Best,the Netherlands),Atrial Fibrillation,LAO 20,J.H. G.-Li, M.Tang, Rapid ventricular pacing to optimize rotational angiography in atrial fibrillation ablation, JICE 2009,Atrial Fibrillation,Qualitative Assessment of RVP Image,J.H. G.-Li, M.Tang, JICE 2009,Atrial Fibrillation,The correlation between PV ostial diameters measured in RVP and CT image,J.H. G.-Li, M.Tang, JICE 2009,Atrial Fibrillation,X-ray dose: LA-3dRA vs. CT,2.7 + 0.9 24.9 + 3.1 ( p 0.001),J.H. G.-Li, M.Tang, JICE 2009,Atrial Fibrillation,3DRA-based Isolation of the RIPV,V1,PV potentials,Atrial Fibrillation,DGK 2009, Mannheim EUROPACE 2009, Berlin,Atrial Fibrillation,Tang M, Gerds-li JH, et al. PACE, 2009,Atrial Fibrillation,RAO,PA,LAO,Side-by-side comparision of 3DRA (left) and CT image (right),Tang M, Gerds-li JH, et al. PACE, 2009,Highly effective and fast Energie: Cryo-ablation high focussed ultrasound (HIFU) laser,New Technologies in AF Ablation (Germany),Atrial Fibrillation,Mapping and Navigation: Real-Time Imaging Using CT-Fluoroscopy Overlay 3DRA ( Philips EP-PreNavigator , Siemens, GE ) Stereotaxis ,Sensei Robotic Catheter System,PVAC,AblationFrontiers),High Density Mapping-Ablation Catheter,Atrial Fibrillation,8 F Multi-electrode-array catheter Maximum Mesh diameter: 30 mm 36 Bipols on two helices of 18 wires each (max. bipole distance: 2.26 mm) Covalent Heparin Coating Fluoro markers for orientation .,High Density Mesh Ablator Catheter TM ( C.R. Bard, Lowell, MA USA),Mesh ablator - RSPV,Atrial Fibrillation,RAO 12,J.H. G.-Li, M.Tang, German Heart Institute Berlin,Atrial Fibrillation,Mesh ablation,J.H. G.-Li, M.Tang, German Heart Institute Berlin,I,II,V1,Mesh 1-3,Mesh 3-5,Mesh 5-7,Mesh 9-11,Mesh 7-9,Mesh 11-13,Mesh 13-15,Mesh 15-17,Mesh 17-19,Mesh 21-23,Mesh 35-1,Mesh 23-25,Mesh 25-27,Mesh 27-29,Mesh 29-31,Mesh 31-33,Mesh 33-35,Mesh 19-21,CS 1-2,CS 3-4,CS 5-6,RVA,pre,ablation,delay,Atrial Fibrillation,Mesh ablation,J.H. G.-Li, M.Tang, German Heart Institute Berlin,I,II,V1,Mesh 1-3,Mesh 3-5,Mesh 5-7,Mesh 9-11,Mesh 7-9,Mesh 11-13,Mesh 13-15,Mesh 15-17,Mesh 17-19,Mesh 21-23,Mesh 35-1,Mesh 23-25,Mesh 25-27,Mesh 27-29,Mesh 29-31,Mesh 31-33,Mesh 33-35,Mesh 19-21,CS 1-2,CS 3-4,CS 5-6,RVA,isolation,Mesh-Stim. exit-block,Mesh ablator vs. Carto X-ray time (min.),J.H. G.-Li, M.Tang, German Heart Institute Berlin,Atrial Fibrillation,27.57 28.10 ( P = 0.941 ),Highly effective and fast Energie: Cryo-ablation high focussed ultrasound (HIFU) laser,New Technologies in AF Ablation (Germany),Atrial Fibrillation,Mapping and Navigation: Real-Time Imaging Using CT-Fluoroscopy Overlay 3DRA ( Philips EP-PreNavigator , Siemens, GE ) Stereotaxis ,Sensei Robotic Catheter System,PVAC, AblationFrontiers),Atrial Fibrillation,PVAC - Pulmonary Vein Ablation Catheter,German Heart Institute Berlin,German Heart Institute Berlin,German Heart Institute Berlin,Ablation Frontiers (MASC),MASC Multi-Array Septal Catheter,Atrial Fibrillation,Ablation Frontiers (MAAC),MAAC Multi-Array Ablation Catheter,Atrial Fibrillation,Ablation Frontiers (MAAC),MAAC Multi-Array Ablation Catheter,Atrial Fibrillation,Ablation Frontiers (T-VAC),T-VAC - Tip-Versatile Ablation Catheter,Atrial Fibrillation,Highly effective and fast PVAC,AblationFrontiers) Energie: Cryo-ablation high focussed ultrasound (HIFU) laser,New Technologies in AF Ablation (Germany),Atrial Fibrillation,Mapping and Navigation: Real-Time Imaging Using CT-Fluoroscopy Overlay 3DRA ( Philips EP-PreNavigator , Siemens, GE ) Stereotaxis ,Sensei Robotic Catheter System,Atrial Fibrillation,German Heart Institute Berlin,Cryo