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房颤消融：冠状窦内放电的依据江江 洪洪武汉大学人民医院武汉大学人民医院2. AF Trigger from CS3. 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 CoatGreatCardiacVeinMiddle Cardiac VeinPosteriorCoronaryVeinIVCLACS Myocardial Coat Conducts ActivationFrom LA to Triangle of Koch2. AF Trigger from CS3. 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 CSCSAT/AF Trigger from CS-49msRF onAblation CatheterCSAT/AF Trigger from CSIsolation of CS endocardially and epicardiallyAT/AF Trigger from CSBefore ablationAfter ablation2. AF Trigger from CS3. Prominent CFAE in CS – CS isolation4. 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消融消融CFAE in CSAblation CFAE in CSAblation CFAE in CS见下面的附注见下面的附注Before ablationAfter ablation2. AF Trigger from CS3. Prominent CFAE in CS – CS isolation4. 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房颤手术时常常需要消融二尖瓣峡部Activation MAP AP ProjectionMitralAnnulus1.0 cmRSPVRIPVLSPV100 ms-100 msAT (CL 200 ms)6 Months Post PV Isolation二尖瓣峡部依赖性房速二尖瓣峡部依赖性房速2. AF Trigger from CS3. Prominent CFAE in CS – CS isolation4. 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内消融的主要风险内消融的主要风险CS穿孔，心包填塞穿孔，心包填塞损伤冠状动脉损伤冠状动脉CS闭塞闭塞损伤食管损伤食管导管嵌顿导管嵌顿LCXLAO Projection50% Stenosisat Site of MCVCSRAALCxCS内消融损伤内消融损伤LCX导管嵌顿导管嵌顿CS临近食管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.RFCryoablation-75C, 4 minutes，， and multiple applications能量推荐能量推荐RecommendationThank YouWelcome to Renmin Hospital of Wuhan University。