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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; 2370Miyasaka.Circulation.2006:119YearYear2.04.06.08.010.012.014.016.0200020052010201520202025 20302035204020452050Adults with AFib (millions) )5.1
2、5.110.210.28.48.412.112.115.915.9美国房颤的者数量预测值（2006年）中国房颤患病率J Epidemiol 2008; 209年龄 男性 女性 平均中国房颤总数 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 200141020252813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;165Incidence of Stroke (/year)%
3、8696房颤/非房颤患者卒中患病率:中国Stroke (n)Non-stroke (n)Total subjects (n)Prevalence of stroke (%)AF2919522412.95Non- AF65728173288552.28Sum68628368290792.36J 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治疗组疗组 病例数卒中例数卒中率 (%) 抗血小板4991 (59.7%) 3346.7抗凝572 (6.6%)325.5未抗栓治 疗疗3062 (35.5
4、%)74124.2Int J Cardiol 2005; 283阵发性房颤的药物治疗现状: 中国Chinese J Cardiol. 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）78.871.5 62.321.228.537.7P0.05Based on 6435 cases registration in ChinaIncreasing needs of Afib ablation from pts in China10002000300040005000房颤导管消融：中国开
5、展医院 116家熟练医生 30人使用仪器 CARTO :60台 EnSite 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 12008年 180,000 8,0002018年 800,000 100,000中国-房颤药物治疗的费
6、用华法林片 0.75 / # RMB胺碘酮片 3.46/# 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 CostChangsheng Ma, M.D. Department of Cardiology Beijing Anzhen Hospital, Capital Medical University Beijing, P.R. China
7、Dem 13, 2008 Prevalence of Diagnosed AF (ATRIA study) JAMA 2001; 2370Project Number of AF in U.S（2001）JAMA 2001; 2370Miyasaka.Circulation.2006:119YearYear2.04.06.08.010.012.014.016.0200020052010201520202025 20302035204020452050Adults with AFib (millions) )5.15.110.210.28.48.412.112.115.915.9Project
8、Number of AF in U.S（2006）Prevalence of Diagnosed AF in ChinaJ Epidemiol 2008; 209年龄 男性 女性 平均中国房颤总数 1000万Age distribution of patients with AFInt J Cardiol 2005; 2834.110.120.125.527.913.3Causes and associated factors for AFInt J Cardiol 2005; 283Incidence of Stroke in patients with NVAFChin J Cardiol
9、 2002;165Incidence of Stroke (/year)%Prevalence of stroke in AF/non-AF cohortsStroke (n)Non-stroke (n)Total subjects (n)Prevalence of stroke (%)AF2919522412.95*Non- AF65728173288552.28Sum68628368290792.36J Epidemiol 2008; 209* P0.001 compared with Non-AFHospitalization increased ChinaChinese J Cardi
10、ol. 2003:913Antithrombotic treatment and stroke rate in AFPatien tsPatients with strokeRate of stroke( %) Antiplatelet49913346.7* #Anticoagulant572325.5*No antithromboti c306274124.2Int J Cardiol 2005; 283* P=0.001 compared with no antithrombotic group # P=0.316 compared with anticoagulant groupTrea
11、tment of paroxysmal AFChinese J Cardiol. 2003:913Treatment of chronic AFChinese J Cardiol. 2003:913Development of transcatheter ablation of AF in ChinaResults of ablation in different type of AF78.871.5 62.321.228.537.7P0.05Based on 6435 cases（China）Increasing needs of Afib ablation from pts in Chin
12、a10002000300040005000Catheter Ablation For Afib in China Hospitals : 116 Experienced Doctors: 30 3D Mapping System CARTO :60 EnSite Navx :30 Magnetic Navigation：2 installed、4 installing、5 will be installed in 2009 Robotic ： 0Approach For Chronic Afib In Chinacircumferential ablation PVIROOF/MI/CTI l
13、inear ablationAbl. of CFAEMapping and Abl. of burst induced Tachy.Make Sure PV/CTI/ROOF/MI/SVC* blockTo Sinus Rryhthm*,（20%) terminated byProject No. of Afib Abl. PCI Afib Catheter Abl. 1998 6,000 12008 180,000 8,0002018 600,000 50,000100,000Costs of AF Medication in ChinaWarfarin tablet 0.75 / # RM
14、BAmiodarone tablet 3.46/# RMB Annual cost 2000 RMB ( VS.1590 Euros*)* PACE 2003; 292Preablation examinations: CT、TEE、TTE、biochemical testCatheter ablation：Abl catheter、Reference pad、Lasso catheterPostablation medication Warfarin、Amiodarone Costs of AF Catheter ablation in ChinaTotal cost: 60,000-80,000 RMB ( VS.5160 Euros*)*PACE 2003; 292Thank you!
