Atriyal Fibrilasyon Tedavisinde Patogenetik Hedefler

Emin Evren Özcan

Dokuz Eylül Üniversitesi

Atriyal Fibrilasyon Ablasyonunda Patogenetik Hedefler

Emin Evren Özcan

Dokuz Eylül Üniversitesi

SCHOTTEN ET AL. Pathophysiological Mechanisms of Atrial Fibrillation. Physiol Rev 91: 265–325, 201.

Haïssaguerre M et al. N Engl J Med. 1998 Sep 3;339(10):659-66.

Hastaların %94’ünde AF tetikleyicileri Pulmoner Venlerden kaynaklanmakta

Pulmoner Ven Rekonneksiyonu

Lin et al. Outcomes After Third or More Catheter Ablation for Atrial Fibrillation Journal of Cardiovascular Electrophysiology Vol. 26, No. 4, April 2015

AF nüksünde kural:PV rekonneksiyonu

Lin et al. Outcomes After Third or More Catheter Ablation for Atrial Fibrillation Journal of Cardiovascular Electrophysiology Vol. 26, No. 4, April 2015

≥3 AF ablasyonu uygulanan 169 hasta

%8

PV dışı tetikleyiciler

Panel a shows the distribution of new non-PV triggers at time of the third or fourth ablations

Lin et al. Outcomes After Third or More Catheter Ablation for Atrial Fibrillation Journal of Cardiovascular Electrophysiology Vol. 26, No. 4, April 2015

36 hastada (%20) yeni PV dışı tetikleyici

Jiang et al. Heart Rhythm, Vol 11, No 6, June 2014

Jiang et al. Heart Rhythm, Vol 11, No 6, June 2014

PVI AF Ablasyonunda köşe taşı mı?

Nademanee K. A new approach for catheter ablation of atrial fibrillation: mapping of the elec- trophysiologic substrate. J Am Coll Car- diol 2004;43:2044-53.

CFAE

• Rotorların sürüklendiği alanlar

• Dalgaların çarpışma yerleri

• Fibrozis alanları

• Bipolar kayıt artefaktları

Çoğu CFAE alanı pasif

%95 olguda DCCV uygulamadan Sinüs Ritmi

Fokal Impuls ve Rotor Modülasyonu

Narayan SM et al. Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM trial. J Am Coll Cardiol 2012;60:628–36.

Narayan SM et al. Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM trial. J Am Coll Cardiol 2012;60:628–36.

Fokal Impuls ve Rotor Modülasyonu

Vücut Yüzeyi Potansiyel Haritalama

Guillem MS. Noninvasive localization of maximal frequency sites of atrial fibrillation by body surface potential map- ping. Circ Arrhythm Electrophysiol. 2013;6:294–301.

Elektrokardiyografik Görüntüleme

Haissaguerre M. Driver domains in persistent atrial fibrillation. Circulation. 2014;130:530–538.

Atriyal Fibrozis ve AF

Marrouche NF et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: The decaaf study. JAMA 2014;311:498–506.

Kottkamp H. Box Isolation of Fibrotic Areas (BIFA): J Cardiovasc Electrophysiol. 2016 Jan;27(1):22-30.

BIFA

Kottkamp H. Box Isolation of Fibrotic Areas (BIFA): J Cardiovasc Electrophysiol. 2016 Jan;27(1):22-30.

Kottkamp H. Box Isolation of Fibrotic Areas (BIFA): J Cardiovasc Electrophysiol. 2016 Jan;27(1):22-30.

BIFA

SCHOTTEN ET AL. Pathophysiological Mechanisms of Atrial Fibrillation. Physiol Rev 91: 265–325, 201.

Otonom Gangliyon Pleksus Ablasyonu

Nakagawa H, et al. Pathophysiologic basis of autonomic ganglionated plexus ablation in patients with atrial fibrillation. Heart Rhythm 2009;6:S26-34.

Bireysel Tedavi Hedefleri

Özet

• Bireysel ablasyon hedefleri

• Kalıcı PVI AF ablasyonunun köşetaşı

• Geniş Antral Çevresel Ablasyon

• Non-PV tetikleyiciler

• Fibrotik atriyumlarda BIFA

• Rotorlar: Hedefi görüyoruz- Ablasyon sonuçları?

• Ampirik hatların hedefi?

SCHOTTEN ET AL. Pathophysiological Mechanisms of Atrial Fibrillation. Physiol Rev 91: 265–325, 201.

Proietti R et al. Comparative effectiveness of wide antral versus ostial pulmonary vein isolation: Circ Arrhythm Electrophysiol. 2014 Feb;7(1):39-45.

STAR AF II

Verma A Approaches to catheter ablation of persistent atrial fibrillation. N Engl J Med 2015;372:1812-1822.

Verma A. N Engl J Med 2015;372:1812-22.

STAR AF II

%59

%48

%44

Fark işlem ve floroskopi süresi