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1、磁导航指导下房颤导管消融并发症分析,无锡市人民医院 王如兴,患者资料,病例:131例磁导航指导下房颤导管消融患者; 性别:男82例,女49例; 年龄:58.010.7(19-78)岁; 房颤类型:阵发性91例,持续性31例和永久性9例。,房间隔穿刺,方法,方法,肺静脉造影,磁消融导管放置与固定,方法,磁导航系统进入导航位,方法,7,术者进入控制室,方法,打开磁导航系统,方法,点击鼠标左房建模,方法,方法,点击界面快捷菜单,标出LSPV,方法,标出LIPV,方法,标出LIPV后左侧建模,方法,标出RSPV,方法,标出RIPV后右侧建模,方法,完成左房建模,Carto,MNS,方法,左房后壁消融,
2、Carto,MNS,方法,左房顶部线性消融,方法,二尖瓣峡部线性消融,方法,131例患者并发症发生情况,死亡 0(例) 心脏穿孔和心包填塞 0(例) 血栓栓塞 0(例) 肺静脉狭窄 0(例) 血胸和气胸 2(例) 无症状脑栓塞 1(例) 出血血肿 0(例) 其他 1(例),血胸2例,锁骨下穿刺所致,无症状脑栓塞1例,Pre-procedure,Post-procedure,颈背部出血1例,抗凝药物所致的自发性出血?,并发症分析,Which one is better ?,Magnetic,Manual,2013年Europace荟萃分析,PV Isolation,AF recurrence,M
3、ajor complications,心脏穿孔和心包填塞,肺静脉狭窄,磁导航 vs. 压力导管-安全性,1Shurrab, et al. Int J Cardiol. 2013 Nov 5;169(3):157-65, 2Stereotaxis Efficiency Study MR-14-001, 3Sciarra, et al. J Interv Card Electrophysiol. 2014 Feb 21. Epub ahead of print, 4Stabile, et al. Europace. 2014 Mar;16(3):335-40., 5Marijon, et al.
4、J Cardiovasc Electrophysiol, Vol. 25, pp. 130-137, 6Natale, et al. SMART-AF Trial. 2012 HRS LBT 02-03, 7Martinek, et al. Pacing Clin Electrophysiol. 2012 Nov;35(11):1312-8., 8Waliki, et al. Clin Res Cardiol. 2014 Feb;103(2):97-106, 9Reddy, et al. Heart Rhythm 2012;9:1789 1795,The largest such study
5、reported an SCL incidence of 14.2% using open irrigation RF catheters.,无症状脑栓塞,Herrera Sikldy C et al. J Am Coll Cardiol. (2011),出血和血肿,Aagaard P, et al. Robotic navigation. for catheter ablation benefits and challenges. Expert Rev Med Devices 2015;12: 457-469.,安全性,J Interv Card Electrophysiol 2015; 4
6、4:1-8.,疗效好:稳定的贴靠,疗效好:有效的消融损伤,J Interv Card Electrophysiol 2015; 44:1-8.,磁导航 vs. 压力导管-疗效,1Shurrab, et al. Int J Cardiol. 2013 Nov 5;169(3):157-65, 2Stereotaxis Efficiency Study MR-14-001, 3Sciarra, et al. J Interv Card Electrophysiol. 2014 Feb 21. Epub ahead of print, 4Stabile, et al. Europace. 2014
7、Mar;16(3):335-40., 5Marijon, et al. J Cardiovasc Electrophysiol, Vol. 25, pp. 130-137, 6Natale, et al. SMART-AF Trial. 2012 HRS LBT 02-03, 7Martinek, et al. Pacing Clin Electrophysiol. 2012 Nov;35(11):1312-8., 8Waliki, et al. Clin Res Cardiol. 2014 Feb;103(2):97-106, 9Reddy, et al. Heart Rhythm 2012
8、;9:1789 1795,磁导航 vs. 压力导管-曝光时间,1Shurrab, et al. Int J Cardiol. 2013 Nov 5;169(3):157-65, 2Stereotaxis Efficiency Study MR-14-001, 3Sciarra, et al. J Interv Card Electrophysiol. 2014 Feb 21. Epub ahead of print, 4Stabile, et al. Europace. 2014 Mar;16(3):335-40., 5Marijon, et al. J Cardiovasc Electrop
9、hysiol, Vol. 25, pp. 130-137, 6Natale, et al. SMART-AF Trial. 2012 HRS LBT 02-03, 7Martinek, et al. Pacing Clin Electrophysiol. 2012 Nov;35(11):1312-8., 8Waliki, et al. Clin Res Cardiol. 2014 Feb;103(2):97-106, 9Reddy, et al. Heart Rhythm 2012;9:1789 1795,小 结,并发症少zero complications 疗效好 医患暴露X线的时间和剂量少 学习曲线短,磁导航指导下心房颤动的导管消融能否完全代替手工消融?,Thank You for your attention!,