1、Clinical Application of 3DRA Imaging and new Catheter-Technique for Afib AblationJ.H.G.- Li, Min Tang, E.Fleck Peking , 11-13.09.2009 German Heart Institute,Berlin,Germany (DHZB) www.dhzb.de,Atrial Fibrillation,AF Prevalence ( 1 ),AF is the most commen arrhythmia“,* EU 2001, US 2006, jeweils zitiert
2、 in Leitlinien 2006 1. Go AS et al. JAMA 2005 2. Fuster V et al. J Am Coll Cardiol 2006,4,5 millions,2,3 millions,0,1,2,3,4,5,USA,EU,AF : - 1 in 25 adults 60 years1 - 1 in 10 adults 80 years1 6,8 millions Patients with AF in EU and USA*1,2,Atrial Fibrillation,Go AS et al. JAMA 2001;285:2370-2375,0,1
3、,0,2,0,4,0,9,1,0,1,7,1,7,3,0,3,4,5,0,5,0,7,3,7,2,10,3,9,1,11,1,0,2,4,6,8,10,12, 55,55-59,60-64,65-69,70-74,75-79,80-84, 85,Age, y,Prevalence %,Prevalence of Diagnosed AF stratified by Age and Sex ( ATRIA-Trial),Men,Women,AF Prevalence ( 2 ),Atrial Fibrillation,Projected Number of Adults With AF in t
4、he United States Between 1995 and 2050,Upper and lower curves represent the upper and lower scenarios based on sensitivity analyses,Adults With Atrial Fibrillation, in millions),Year,2050,2045,2040,2035,2030,2025,2020,2015,2010,2005,2000,1995,1990,0,0,1,0,2,0,3,0,4,0,5,0,6,0,7,0,Go AS et al. JAMA 20
5、01;285:2370-2375,2,08,2,44,2,26,2,66,2,94,3,33,3,80,4,34,4,78,5,16,5,42,5,61,AF Prevalence ( 3 ),Atrial Fibrillation,Haissaguerre M ,et al N Engl J Med 1998, focal AF“,Atrial Fibrillation,Conventional Ablation Strategy for AF,CartoMerge NavX with CT-Image CPVA + ,Atrial Fibrillation,Highly effective
6、 and fast PVAC,AblationFrontiers) Energie: Cryo-ablation high focussed ultrasound (HIFU)laser,New technologies in AF Ablation (Germany),Atrial Fibrillation,Mapping and Navigation: Real-Time Imaging Using CT-Fluoroscopy Overlay 3DRA ( Philips EPre-Navigator , Siemens, GE ) Stereotaxis ,Sensei Robotic
7、 Catheter System,Atrial Fibrillation,3DRA ( German Heart Institute Berlin ),Metherd: - Adenosine (30-40 mg) i.v. asystole & av-block - Rapid ventricular Pacing, Key point: Atrium Low-output,3DRA,from RAO 55 to LAO 55,from RAO 110to LAO 110,Rotationalangiography (3DRA),Atrial Fibrillation,German Hear
8、t Institute Berlin,Atrial Fibrillation,CONCLUSION: Intra-procedural contrast-enhanced rotational angiography of the LA-PV during adenosine-induced asystole is feasible and provides anatomical information of high diagnostic value for atrial fibrillation ablation.,Atrial Fibrillation,Atrial Fibrillati
9、on,arterial pressure and ECG monitor display,LA-3DRA ( by adenosine ),DHZB (with Allura xper FD 10; Philips Medical System,Best,the Netherlands),J.H. G.-Li, M.Tang, German Heart Institute Berlin,Atrial Fibrillation,LA-3DRA vs. CT,DHZB (with Allura xper FD 10; Philips Medical System,Best,the Netherla
10、nds),Atrial Fibrillation,Kriatselis C, Tang M, et al. Heart Rhythm 2009,Atrial Fibrillation,3DRA by rapid ventricular Pacing,No. of patients: 41,Atrial Fibrillation,arterial pressure and ECG monitor display,LA-3DRA ( by RVP ),DHZB (with Allura xper FD 10; Philips Medical System,Best,the Netherlands)
11、,J.H. G.-Li, M.Tang, JICE 2009,Atrial Fibrillation,LA-3DRA vs. CT,DHZB (with Allura xper FD 10; Philips Medical System,Best,the Netherlands),Atrial Fibrillation,LAO 20,J.H. G.-Li, M.Tang, Rapid ventricular pacing to optimize rotational angiography in atrial fibrillation ablation, JICE 2009,Atrial Fi
12、brillation,Qualitative Assessment of RVP Image,J.H. G.-Li, M.Tang, JICE 2009,Atrial Fibrillation,The correlation between PV ostial diameters measured in RVP and CT image,J.H. G.-Li, M.Tang, JICE 2009,Atrial Fibrillation,X-ray dose: LA-3dRA vs. CT,2.7 + 0.9 24.9 + 3.1 ( p 0.001),J.H. G.-Li, M.Tang, J
13、ICE 2009,Atrial Fibrillation,3DRA-based Isolation of the RIPV,V1,PV potentials,Atrial Fibrillation,DGK 2009, Mannheim EUROPACE 2009, Berlin,Atrial Fibrillation,Tang M, Gerds-li JH, et al. PACE, 2009,Atrial Fibrillation,RAO,PA,LAO,Side-by-side comparision of 3DRA (left) and CT image (right),Tang M, G
14、erds-li JH, et al. PACE, 2009,Highly effective and fast Energie: Cryo-ablation high focussed ultrasound (HIFU)laser,New Technologies in AF Ablation (Germany),Atrial Fibrillation,Mapping and Navigation: Real-Time Imaging Using CT-Fluoroscopy Overlay 3DRA ( Philips EP-PreNavigator , Siemens, GE ) Ster
15、eotaxis ,Sensei Robotic Catheter System,PVAC,AblationFrontiers),High Density Mapping-Ablation Catheter,Atrial Fibrillation,8 F Multi-electrode-array catheterMaximum Mesh diameter: 30 mm36 Bipols on two helices of 18wires each (max. bipole distance:2.26 mm)Covalent Heparin CoatingFluoro markers for o
16、rientation .,High Density Mesh Ablator Catheter TM ( C.R. Bard, Lowell, MA USA),Mesh ablator - RSPV,Atrial Fibrillation,RAO 12,J.H. G.-Li, M.Tang, German Heart Institute Berlin,Atrial Fibrillation,Mesh ablation,J.H. G.-Li, M.Tang, German Heart Institute Berlin,I,II,V1,Mesh 1-3,Mesh 3-5,Mesh 5-7,Mesh
17、 9-11,Mesh 7-9,Mesh 11-13,Mesh 13-15,Mesh 15-17,Mesh 17-19,Mesh 21-23,Mesh 35-1,Mesh 23-25,Mesh 25-27,Mesh 27-29,Mesh 29-31,Mesh 31-33,Mesh 33-35,Mesh 19-21,CS 1-2,CS 3-4,CS 5-6,RVA,pre,ablation,delay,Atrial Fibrillation,Mesh ablation,J.H. G.-Li, M.Tang, German Heart Institute Berlin,I,II,V1,Mesh 1-
18、3,Mesh 3-5,Mesh 5-7,Mesh 9-11,Mesh 7-9,Mesh 11-13,Mesh 13-15,Mesh 15-17,Mesh 17-19,Mesh 21-23,Mesh 35-1,Mesh 23-25,Mesh 25-27,Mesh 27-29,Mesh 29-31,Mesh 31-33,Mesh 33-35,Mesh 19-21,CS 1-2,CS 3-4,CS 5-6,RVA,isolation,Mesh-Stim. exit-block,Mesh ablator vs. Carto X-ray time (min.),J.H. G.-Li, M.Tang, G
19、erman Heart Institute Berlin,Atrial Fibrillation,27.57 28.10 ( P = 0.941 ),Highly effective and fast Energie: Cryo-ablation high focussed ultrasound (HIFU)laser,New Technologies in AF Ablation (Germany),Atrial Fibrillation,Mapping and Navigation: Real-Time Imaging Using CT-Fluoroscopy Overlay 3DRA (
20、 Philips EP-PreNavigator , Siemens, GE ) Stereotaxis ,Sensei Robotic Catheter System,PVAC, AblationFrontiers),Atrial Fibrillation,PVAC - Pulmonary Vein Ablation Catheter,German Heart Institute Berlin,German Heart Institute Berlin,German Heart Institute Berlin,Ablation Frontiers (MASC),MASC Multi-Arr
21、ay Septal Catheter,Atrial Fibrillation,Ablation Frontiers (MAAC),MAAC Multi-Array Ablation Catheter,Atrial Fibrillation,Ablation Frontiers (MAAC),MAAC Multi-Array Ablation Catheter,Atrial Fibrillation,Ablation Frontiers (T-VAC),T-VAC - Tip-Versatile Ablation Catheter,Atrial Fibrillation,Highly effec
22、tive and fast PVAC,AblationFrontiers) Energie: Cryo-ablation high focussed ultrasound (HIFU)laser,New Technologies in AF Ablation (Germany),Atrial Fibrillation,Mapping and Navigation: Real-Time Imaging Using CT-Fluoroscopy Overlay 3DRA ( Philips EP-PreNavigator , Siemens, GE ) Stereotaxis ,Sensei Ro
23、botic Catheter System,Atrial Fibrillation,German Heart Institute Berlin,CryoConsole,Balloon catheter,Atrial Fibrillation,Cryo-Balloon with ProMAP-catheter,Min Tang， Jin-Hong Gerds-li, et al. Journal of Cardiovascular Electrophysiology, in press,Atrial Fibrillation,Cryo-Balloon with ProMAP-catheter,M
24、in Tang，Jing-Hong Gerds-li, et al. Journal of Cardiovascular Electrophysiology, in press,Min Tang， et al. Journal of Cardiovascular Electrophysiology, in press,Min Tang， et al. Journal of Cardiovascular Electrophysiology, in press,Atrial Fibrillation,LA-3DRA,German Heart Institute Berlin,LA-3DRA is able to delineate theLA-PV anatomyGood correlation in the PV ostialdiameters with 3DRA and CT imagingCombined Use of LA-3DRA and new catheter-techniquefacilitates AF ablation,Thanks !,DHZB - welcome !,Here we are!,
