房颤消融Microwave_Ablation_For_Chronic_Atrial_Fibrillation.ppt

Microwave Ablation For Chronic Atrial Fibrillation Li Poa, M.D., F.A.C.S. Director of Perioperative Services Enloe Medical Center Chico, California The Future of Cardiac Intervention (National Health Council) Stent and intravascular intervention expected to double over next 3 years CABG volume to decline about 10% with cardiac surgery primarily expanding in EPS and CHF such as ablative surgery, biventricular pacing, LV remodeling, and cardiac muscle augmentation. Valvular volume to increase about 20% by 2005 Chronic Atrial Fibrillation Affects 2 million people in the US alone with a 9% 5 year morbidity from anticoagulation and a 5% / year risk of stroke As high as an 80 % risk of stroke at 8 years in the Japanese study group (Kitamura) Available treatment modalities include surgical “Maze”, cryotherapy, radiofrequency, irrigating radiofrequency, microwave, and laser Surgical Maze success best overall but Microwave has the least complications and the best ease of use Microwave Ablation: ~ 3000 patients Open Heart 2300 patients 75% success - 0 to 4 year follow up Dresden Experience 211 consecutive patients with documented atrial fibrillation for average of 6.8 years concomitant MVR, CABG, AVR, and TVR Survival 98%, no MW complications 70% NSR at 6 months 68% NSR at 1 year with normal atrial transport function 23% had a postop PPM implant Comparative study on Concomitant Atrial Fibrillation Group A - 62 patients with no ablation during surgery survival 94.2% NSR in 6% of MVD; 9% with CAD; and 5% with AVD disease processes Group B - 88 patients receiving MW ablation with their surgery survival 98% NSR in 62% of MVD; 70% with CAD; and 82% with AVD disease processes Dr. David Kress and Dr. Murali Dharan 20 patients (18 epicardial, 2 endocardial) 100% left OR in sinus or paced rhythm 75% free of AF at discharge 73% of chronic pts free of AF at 3 months (11/15) 80% pf paroxysmal pts free of AF at 3 months (4/5) No perioperative complications, deaths, or co