房颤消融术后房性心律失常的处理和二次消融选择PPT课件.ppt

房颤消融术后房性心律失常的处理和二次消融选择背景Background与房颤消融相关的左房房扑(LAFL)~31%[1];ThemorbidityofAFablationrelatedleftatrialflutter(LAFL)~31%;包括局灶、大折返或小折返等多种机制且多与房颤消融线的“缝隙”有关;Focal、micro-&macro-reentrantmechanismsweredocumentedandthegaponthelesionslineisthestickingpointofthecircuit;1,GerstenfeldEP,HeartRhythm2007;4:S65-72个体化递进式线性消融术StepwiseLinearAblationApproach病例数Patients(n)80性别Gender:男性(M)/女性(F)60/20年龄Age(岁,years)57±9房颤持续时间DurationofAF(年,years)7±4阵发性Paroxysmal/持续性房颤PersistentAF62/18左房内径LAdiameter(mm)38±8左室射血分数LVEF(%)52±6器质性心脏病StructralHeartDisease16(20%)既往抗心律失常药物AADs(n)2±1LAFL患者基本特点haracteristicsofLAFLPatients结果ResultsLAFL可在消融中由AF转化而成,或房颤消融成功之后快速刺激诱发;LAFLswereeitherconvertedfromAFbyablationorinducedbyCIS;34例有≥2(2~6)种的LAFL,共有146种,其中4种为局灶性,142种为大折返机制;≥2(2~6)LAFLs,oftotal146LAFLs,142werereentrant&4werefocal;142种LAFL均与房颤消融线的缝隙有关,且均位于7字消融线上;ThereentrantcircuitswereallrelatedwiththegapsontheFigure“7”:绕MVA的折返**********msLeadIISOCHRONES绕二尖瓣环的折返(IsochronalmapoftheMVAcircuit);%;;经MVA-LIPV峡部的“缝隙”ThegaponMVA-LIPVisthmus在峡部缝隙处消融转为窦律TerminationoftheLAFL