冷冻消融疗法介绍和国内外进展b__培训课件.pptxVIP

冷冻球囊房颤消融疗法介绍及国内外进展内容第一部分：冷冻消融原理及安全性优势荟萃分析（有效性及并发症）可重复性及学习曲线第二部分冷冻消融系统组成及耗材简介概述冷冻球囊消融手术的步骤及重点策略第三部分国内外进展冷冻球囊治疗已成为房颤消融的标准疗法—HRS专家共识2012 HRS Consensus Statement12014 AHA/ACC/HRS Guidelines2Catheter ablation updated to Class I with Level of Evidence A for drug refractory symptomatic paroxysmal AF “… point-by-point RF energy andCryoballoon ablation are the twostandard ablation systems used forcatheter ablation of AF today . . .”2005年Arctic Front冷冻球囊正式在欧洲开始应用1. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design. Heart Rhythm. April 2012;9(4):632-696.2. January, et al. 2014 AHA/ACC/HRS Guidelines for the Management of Patient with Atrial Fibrillation. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. JACC. 10.1016/j.jacc.2014.03.021第一部分：冷冻消融原理及安全性优势荟萃分析（有效性及并发症）可重复性及学习曲线冷冻消融通过连续的疤痕达到肺静脉隔离，而不是通过多次的不连续的能量传递减少肺静脉重连的复发减小并发症的风险血栓附带损伤, 肺静脉狭窄, 食管损伤，AVBLOCK(冷冻大头消融AVNRT,HIS旁旁路)提高手术的耐受冷冻消融原理冷冻消融压缩的液态N2O蒸发时吸走组织内的热量,使组织冷却/结冰,进而影响细胞活性和功能损伤灶组织学对比: 冷冻法和射频法最小的血栓心内膜完整心内膜破坏出现血栓纤维结构完整界限清晰还有出血纤维化开始冷冻瘢痕一星期时 (犬模型)射频疤痕一周时(犬模型) -75 °C ? 1 x 4 分钟+70 °C ? 50 W ? 60 秒Khairy P, et al. Circulation. 2003;107:2045-2050.Cryo:RF:Minimal Tissue disruption reduces potential for thrombus and stenosisGreater degree of tissue disruption increases the risk of “steam pops”, perforation and thrombus损伤灶组织学对比RFCryo血栓出现最小化心内膜组织破坏完整纤维化开始完整出血仍存在无边界不清晰清晰潜在并发症比较: 冷冻法和射频法RFCryo血栓形成有最小化PV狭窄有有食道损伤有有房室结传导阻滞有通常可逆冠状窦损伤有无膈神经麻痹最小化有荟萃分析（有效性及并发症）: 荟萃分析：23项纳入研究详情人口统计学手术特征1387 患者 109 持续性房颤以男性为主(73.6%)年龄 57.5 ± 1.9y正常左室射血分数和左房直径高血压合并症为主 (37.8%)罕见的结构性心脏病(10.8%)手术时间 : 206.3 ± 72.2 分钟曝光时间: 46.0 ± 13.3 分钟显著 ↓ 熟悉28 mm 冷冻球囊占 80.1% (681/842)23mm 冷冻球囊占13.9% (117/842)两者都使用5.3% (44/842)14 项研究 (932 名患者) – 结合结合冷冻消融和局灶消融(超过17