1、房颤-流行病与医疗费用,董建增 马长生 首都医科大学附属北京安贞医院,房颤的患病率 -ATRIA 研究,JAMA 2001; 2370,北加州 189万 人口 17974 例成人房颤患者 （July 1, 1996 - December 31, 1997）,美国房颤患者预测数量（ 2001年）,JAMA 2001; 2370,Miyasaka.Circulation.2006:119,Year,美国房颤的者数量预测值（2006年）,中国房颤患病率,J Epidemiol 2008; 209,中国房颤总数 1000万,中国-房颤患者的年龄构成,Int J Cardiol 2005; 283,回顾
2、分析来自中国41家医院9297例诊断房颤出院患者资料Jan 1999-Dec 2001,4,10,20,25,28,13,房颤病因以及相关发病因素（中国）,Int J Cardiol 2005; 283,非瓣膜病房颤卒中率（不抗凝）-中国,Chin J Cardiol 2002;165,8696,房颤/非房颤患者卒中患病率:中国,J Epidemiol 2008; 209,房颤患者住院率增加: 中国,Chinese J Cardiol. 2003:913,房颤患者的抗栓治疗和脑卒中发生率,Int J Cardiol 2005; 283,阵发性房颤的药物治疗现状: 中国,Chinese J Ca
3、rdiol. 2003:913,慢性房颤的药物治疗: 中国,Chinese J Cardiol. 2003:913,中国房颤经导管消融治疗的发展趋势,不同类型房颤经导管消融疗效（中国）,78.8,71.5,62.3,21.2,28.5,37.7,P0.05,Based on 6435 cases registration in China,Increasing needs of Afib ablation from pts in China,1000,2000,3000,4000,5000,房颤导管消融：中国,开展医院 116家 熟练医生 30人 使用仪器 CARTO :60台 EnSite
4、Navx :30台 磁导航系统：2台已装、4台在装、5台订购 机器人： 0,慢性房颤消融策略(马长生等，2008),环PV消融至PV隔离或接近隔离,ROOF/MI/CTI消融,CFAE消融（右间隔、CS、心耳根部、间隔部等等）,对诱发的心动过速进一步标测消融,进一步验证并保证PV/CTI/ROOF/MI/SVC* 阻滞,消融至窦性*，房颤不中止者BURST/（20%）,房颤导管消融,冠心病PCI 房颤导管消融 1998年 6,000 1 2008年 180,000 8,000 2018年 800,000 100,000,中国-房颤药物治疗的费用,华法林片 0.75 / # RMB 胺碘酮片 3
5、.46/# RMB 年医药费 2000 RMB,消融前检查: CT、TEE、TTE、生化指标等导管消融：消融导管、参考电极、Lasso导管等术后用药华法令、胺碘酮,中国-导管消融的费用,总体花费: 60,000 - 80,000 RMB,谢谢,Atrial fibrillation： The Epidemic and Cost,Changsheng Ma, M.D. Department of Cardiology Beijing Anzhen Hospital, Capital Medical University Beijing, P.R. ChinaDem 13, 2008,Preval
6、ence of Diagnosed AF (ATRIA study),JAMA 2001; 2370,Project Number of AF in U.S（2001）,JAMA 2001; 2370,Miyasaka.Circulation.2006:119,Year,Project Number of AF in U.S（2006）,Prevalence of Diagnosed AF in China,J Epidemiol 2008; 209,中国房颤总数 1000万,Age distribution of patients with AF,Int J Cardiol 2005; 28
7、3,4.1,10.1,20.1,25.5,27.9,13.3,Causes and associated factors for AF,Int J Cardiol 2005; 283,Incidence of Stroke in patients with NVAF,Chin J Cardiol 2002;165,Prevalence of stroke in AF/non-AF cohorts,J Epidemiol 2008; 209,* P0.001 compared with Non-AF,Hospitalization increased China,Chinese J Cardio
8、l. 2003:913,Antithrombotic treatment and stroke rate in AF,Int J Cardiol 2005; 283,* P=0.001 compared with no antithrombotic group # P=0.316 compared with anticoagulant group,Treatment of paroxysmal AF,Chinese J Cardiol. 2003:913,Treatment of chronic AF,Chinese J Cardiol. 2003:913,Development of tra
9、nscatheter ablation of AF in China,Results of ablation in different type of AF,78.8,71.5,62.3,21.2,28.5,37.7,P0.05,Based on 6435 cases（China）,Increasing needs of Afib ablation from pts in China,1000,2000,3000,4000,5000,Catheter Ablation For Afib in China,Hospitals : 116Experienced Doctors: 303D Mapp
10、ing System CARTO :60 EnSite Navx :30 Magnetic Navigation：2 installed、4 installing、5 will be installed in 2009Robotic ： 0,Approach For Chronic Afib In China,circumferential ablation PVI,ROOF/MI/CTI linear ablation,Abl. of CFAE,Mapping and Abl. of burst induced Tachy.,Make Sure PV/CTI/ROOF/MI/SVC* blo
11、ck,To Sinus Rryhthm*,（20%) terminated by,Project No. of Afib Abl.,PCI Afib Catheter Abl. 1998 6,000 1 2008 180,000 8,000 2018 600,000 50,000100,000,Costs of AF Medication in China,Warfarin tablet 0.75 / # RMB Amiodarone tablet 3.46/# RMB Annual cost 2000 RMB ( VS.1590 Euros*),* PACE 2003; 292,Preablation examinations: CT、TEE、TTE、biochemical testCatheter ablation：Abl catheter、Reference pad、Lasso catheterPostablation medication Warfarin、Amiodarone,Costs of AF Catheter ablation in China,Total cost: 60,000-80,000 RMB ( VS.5160 Euros*),*PACE 2003; 292,Thank you!,
