房颤消融：冠状窦内放电的依据江洪.ppt

房颤消融：冠状窦内放电的依据,江 洪 武汉大学人民医院,2. AF Trigger from CS,3. Prominent CFAE in CS - CS隔离,4. AT/AF Mitral isthmus ablation in CS,1.冠状窦的特殊结构,5. 冠状窦内放电的能量选择和安全性,CS Myocardial Coat,Great Cardiac Vein,Middle Cardiac Vein,Posterior Coronary Vein,IVC,LA,CS Myocardial Coat Conducts Activation From LA to Triangle of Koch,2. AF Trigger from CS,3. Prominent CFAE in CS - CS隔离,4. AT/AF Mitral isthmus ablation in CS,1.冠状窦的特殊结构,5. 冠状窦内放电的能量选择和安全性,AT/AF Trigger from CS,CS,AT/AF Trigger from CS,-49ms,RF on,Ablation Catheter,CS,AT/AF Trigger from CS,Isolation of CS endocardially and epicardially,AT/AF Trigger from CS,Before ablation,After ablation,2. AF Trigger from CS,3. Prominent CFAE in CS CS isolation,4. AT/AF Mitral isthmus ablation in CS,1.冠状窦的特殊结构,5. 冠状窦内放电的能量选择和安全性,CFAE Ablation,CFAE消融,CFAE in CS,Ablation CFAE in CS,Ablation CFAE in CS,见下面的附注,Before ablation,After ablation,2. AF Trigger from CS,3. Prominent CFAE in CS CS isolation,4. AT/AF Mitral isthmus ablation in CS,1.冠状窦的特殊结构,5. 冠状窦内放电的能量选择和安全性,房颤手术时常常需要消融二尖瓣峡部,Activation MAP,AP Projection,Mitral Annulus,1.0 cm,RSPV,RIPV,LSPV,100 ms,-100 ms,AT (CL 200 ms),6 Months Post PV Isolation,二尖瓣峡部依赖性房速,2. AF Trigger from CS,3. Prominent CFAE in CS CS isolation,4. AT/AF Mitral isthmus ablation in CS,1.冠状窦的特殊结构,5. 冠状窦内放电的能量选择和安全性,CS内消融的主要风险,CS穿孔，心包填塞,损伤冠状动脉,CS闭塞,损伤食管,导管嵌顿,LCX,LAO Projection,50% Stenosis at Site of MCV,CS,RAA,LCx,CS内消融损伤LCX,导管嵌顿,CS临近食管,食管,食管,易损伤食管,不易损伤食管,25 to 30W for epicardial ablation within the CS. Irrigation rates of 5 to 60 mL/min were used to achieve the desired power delivery.,RF,Cryoablation,-75C, 4 minutes， and multiple applic