1 / 30

Katheterablatie van atriumfibrilleren

Katheterablatie van atriumfibrilleren. Waar staan we? Lukas Dekker. Ik sta meestal hier. Katheterablatie van atriumfibrilleren. Waar staan we? = Outcome Lukas Dekker. Agenda. What are the relevant endpoints? Outcome in paroxysmal, persistent and permanent AFib .

emele
Download Presentation

Katheterablatie van atriumfibrilleren

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Katheterablatie van atriumfibrilleren Waarstaan we? Lukas Dekker

  2. Ikstameestalhier

  3. Katheterablatie van atriumfibrilleren Waarstaan we? = Outcome Lukas Dekker

  4. Agenda • What are the relevant endpoints? • Outcome in paroxysmal, persistent and permanent AFib. • Potential determinants of outcome. • Longterm follow up. • Outcome in structural heart disease. • Outcome in various age groups.

  5. What are relevant endpoints? Potential endpoints • Symptoms. Asymptomatic episodes occur, and probably more often after PVI. • ECG monitoring. The more, the lower the success. • Long term endpoints. Often only 1 yr follow up. • With or without AAD. Often put together. • ‘Hard endpoints’. Reduction of stroke and mortality? • Health economics. PVI seems cost-effective after 4 y.

  6. What are relevant endpoints? Symptoms will fool you Quirino et al. PACE. 2009;32:91-98

  7. What are relevant endpoints? Method of monitoring 1- or 7-day Holter at 0,3,6,12 m. Kottkamp et al. JACC. 2004

  8. Outcome in paroxysmal, persistent and permanent AFib Outcome: the surgeon leads the way 95% SR QoL MAZE for lone AFib Jessurun, Circulation 2000;101:1559-67 Lönnerholm, Circulation 2000;101:2607-11

  9. Outcome in paroxysmal, persistent and permanent AFib Paroxysmal AFib The A4 study. 1,8 PVI per patient. 24 hHolter at 3,6, 12 m. Endpoint: >3’ AF or symptoms Jais et al. Circulation.2008;118:2498-2505

  10. Outcome in paroxysmal, persistent and permanent AFib Long lasting, persistent AFib LA termination. 12 yAFib RA termination. 23 yAFib No termination. 35 yAFib Stepwise approach for persistent AFib Hocini et al. JACC. 2010;55:1007-1016

  11. Outcome in paroxysmal, persistent and permanent AFib Permanent AFib CPVA= circumferential PV-ablation PVAI = PV-isolation PVAI = PV-isolation + CFAE-ablation Elayi et al. Heart Rhythm. 2008.5:1658-1664

  12. Outcome in paroxysmal, persistent and permanent AFib Permanent AFib

  13. Outcome in paroxysmal, persistent and permanent AFib Ultra-structural remodeling

  14. Outcome in paroxysmal, persistent and permanent AFib Outcome depends on input Fisher JD, et al. PACE 2006;29:523-537

  15. Potential determinants of outcome Haïssaguerre’sApproach Haissaguerre et al. NEJM. 1998;339:659-666

  16. Potential determinants of outcome Circumferential ablation

  17. Potential determinants of outcome SegmentalorCircumferential? Karch et al.Circulation 2005 Oral et al. Circulation 2003

  18. Potential determinants of outcome Size matters Cappato et al. Circulation.2005;111:1100-1105

  19. Potential determinants of outcome Size really matters Cappato et al. Circulation.2005;111:1100-1105

  20. Atrial size matters too N=88 Parikh et al. PACE. 2010;33:523-540

  21. Long term follow up Some patients probably surrender more easily

  22. Long term follow up The future remains full of questions FU 38 m. after PVI for persistent AFib Pratola et al. Circulation. 2008;117:136-143

  23. Long term follow up Do not forget about your patient! Hypertension! Anticoagulation? AF-free 1 yr after PVI without AAD Shah et al. JCE. 2008;19:661-667

  24. Outcome in structural heart disease PVI in HCM =on/off AAD =off AAD Bunch et al. JCE. 2008

  25. Outcome in structural heart disease PVI in heart failure Change in LVEF (n=58) SR in 78% Hsu et al. NEJM. 2004; 351:2373-2383

  26. Outcome in structural heart disease PVI in “heart failure” Hsu et al. NEJM. 2004; 351:2373-2383

  27. Outcome in various age groups PVI as first line therapy in the young? N=308 N=232 N=438 N=570 0% complications Leong-Sit et al. Circ A&E.2010;3:452-457

  28. Outcome in various age groups AFib is agedependent

  29. Outcome in various age groups PULMONARY VEIN ABLATION VERSUS AMIODARONE IN THE ELDERLY PAVANE

  30. Conclusions • PVI has developed into a very efficacious treatment. • PVI may be on its way to become first line therapy in selected patients, such as the young. • More data on hard endpoints and longterm follow-up are needed.

More Related