内科学教学资料：第三篇循环系统疾病第一章 总论 最终稿.pptVIP

起搏器电极 被动电极 主动电极 起搏器埋置 先天性心脏病经皮封堵术 房缺封堵 心脏瓣膜的介入治疗 20世纪80年代开始的瓣膜病球囊扩张成形术 经皮主动脉瓣置入术(TAVI) 二尖瓣关闭不全经皮修补术 二尖瓣球囊扩张术 经皮主动脉瓣置换术 心脏外科手术 冠状动脉搭桥术 心脏瓣膜修补术 先天性心脏病矫治手术 心包剥离术 心脏移植 其它治疗 基因治疗 干细胞移植 其它 如：经导管消融肾交感神经去除术（ARDN） Thanks Catheter Ablation for Paroxysmal Atrial Fibrillation Segmental Pulmonary Vein Ostial Ablation Versus Left Atrial Ablation Hakan Oral, MD; Christoph Scharf, MD; Aman Chugh, MD; Burr Hall, MD; Peter Cheung, MD; Eric Good, DO; Srikar Veerareddy, MD; Frank Pelosi, Jr, MD; Fred Morady, MD Background—Segmental ostial catheter ablation (SOCA) to isolate the pulmonary veins (PVs) and left atrial catheter ablation (LACA) to encircle the PVs both may eliminate paroxysmal atrial fibrillation (PAF). The relative efficacy of these 2 techniques has not been directly compared. Methods and Results—Of 80 consecutive patients with symptomatic PAF (age, 5210 years), 40 patients underwent PV isolation by SOCA and 40 patients underwent LACA to encircle the PVs. During SOCA, ostial PV potentials recorded with a ring catheter were targeted. LACA was performed by encircling the left- and right-sided PVs 1 to 2 cm from the ostia and was guided by an electroanatomic mapping system; ablation lines also were created in the mitral isthmus and posterior left atrium. The mean procedure and fluoroscopy times were 15645 and 5017 minutes for SOCA and 14933 and 3912 minutes for LACA, respectively. At 6 months, 67% of patients who underwent SOCA and 88% of patients who underwent LACA were free of symptomatic PAF when not taking antiarrhythmic drug therapy (P0.02). Among the variables of age, sex, duration and frequency of PAF, ejection fraction, left atrial size, structural heart disease, and the ablation technique, only an increased left atrial size and the SOCA technique were independent predictors of recurrent PAF. The only complication was left atrial flutter in a patient who underwent LACA. Conclusions—In patients undergoing catheter ablation for PAF, LACA to encircle the PVs