1、房颤消融：冠状窦内放电的依据房颤消融：冠状窦内放电的依据 江 洪 武 汉 大学人民医院 2. AF Trigger from CS 3. Prominent CFAE in CS - CS隔离 4. AT/AF Mitral isthmus ablation in CS 1.冠状窦的特殊结构 5. 冠状窦内放电的能量选择和安全性 CS Myocardial Coat Great Cardiac Vein Middle Cardiac Vein Posterior Coronary Vein IVC LA CS Myocardial Coat Conducts Activation From L
2、A to Triangle of Koch 2. AF Trigger from CS 3. Prominent CFAE in CS - CS隔离 4. AT/AF Mitral isthmus ablation in CS 1.冠状窦的特殊结构 5. 冠状窦内放电的能量选择和安全性 AT/AF Trigger from CS CS AT/AF Trigger from CS -49ms RF on Ablation Catheter CS AT/AF Trigger from CS Isolation of CS endocardially and epicardially AT/AF T
3、rigger from CS Before ablation After ablation 2. AF Trigger from CS 3. Prominent CFAE in CS CS isolation 4. AT/AF Mitral isthmus ablation in CS 1.冠状窦的特殊结构 5. 冠状窦内放电的能量选择和安全性 CFAE Ablation CFAE消融 CFAE in CS Ablation CFAE in CS Ablation CFAE in CS 见下面的附注 Before ablation After ablation 2. AF Trigger fr
4、om CS 3. Prominent CFAE in CS CS isolation 4. AT/AF Mitral isthmus ablation in CS 1.冠状窦的特殊结构 5. 冠状窦内放电的能量选择和安全性 房颤手术时常常需要消融二尖瓣峡部 Activation MAP AP Projection Mitral Annulus 1.0 cm RSPV RIPV LSPV 100 ms -100 ms AT (CL 200 ms) 6 Months Post PV Isolation 二尖瓣峡部依赖性房速 2. AF Trigger from CS 3. Prominent CF
5、AE in CS CS isolation 4. AT/AF Mitral isthmus ablation in CS 1.冠状窦的特殊结构 5. 冠状窦内放电的能量选择和安全性 CS内消融的主要风险 CS穿孔，心包填塞 损伤冠状动脉 CS闭塞 损伤食管 导管嵌顿 LCX LAO Projection 50% Stenosis at Site of MCV CS RAA LCx CS内消融损伤 LCX 导管嵌顿 CS临近食管 食管 食管 易损伤食管不易损伤食管 25 to 30W for epicardial ablation within the CS. Irrigation rates of 5 to 60 mL/min were used to achieve the desired power delivery. RF Cryoablation -75C, 4 minutes， and multiple applications 能量推荐 Recommendation Thank You Welcome to Renmin Hospital of Wuhan University
