L ABLATION DANS LES ABLATION DANS LES L ARYTHMIES ARYTHMIES - - PowerPoint PPT Presentation

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L ABLATION DANS LES ABLATION DANS LES L ARYTHMIES ARYTHMIES - - PowerPoint PPT Presentation

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L ABLATION DANS LES ABLATION DANS LES L ARYTHMIES ARYTHMIES SUPRAVENTRICULAIRES SUPRAVENTRICULAIRES PROF L DE ROY UNIVERSITE DE LOUVAIN BELGIQUE AV NODE ABLATION AV NODE ABLATION RF ON ACCESSORY PATHWAYS ACCESSORY PATHWAYS RF

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L L’ ’ ABLATION DANS LES ABLATION DANS LES ARYTHMIES ARYTHMIES SUPRAVENTRICULAIRES SUPRAVENTRICULAIRES

PROF L DE ROY UNIVERSITE DE LOUVAIN BELGIQUE

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RF ON

AV NODE ABLATION AV NODE ABLATION

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ACCESSORY PATHWAYS ACCESSORY PATHWAYS

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RF ON P., A. (840120)

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511026

RF ON

A A A A A A A

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ACCESSORY PATHWAYS ACCESSORY PATHWAYS

Palpitations : HR : 260 - 280/min AF : CL < 180 ms Syncope : 11 - 29 % Cardiac arrest : 0.15-0.39 % (3-10y) (1/1000 pts y) RF ABL. : Success : 95 % Recurrences : 5 %

Munger circ 1993 Leitch circ 1990 Calkins circ 1999 Lesh JACC 1993

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ACC/AHA/ESC Guidelines for Management of Patients With Supraventricular Arrhythmias 2003

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S/F:77% S/F:77% S/S:11% S/S:11% F/S:12% F/S:12%

AV NODAL TACHYCARDIA

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  • L. M. 380522 / 98153
  • L. M. 380522 / 98153

25 mm/sec

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AVN

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AV NODAL TACHYCARDIA

Palpitations : HR : 240/min AF Syncopes : 33 - 39 % Cardiac arrest : anecdotal RF ABL. : Success : 96.1 % Recurrences : 3-7 %

Scheinman Pace 2000 Clague Eur H J 2001

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ACC/AHA/ESC Guidelines for Management of Patients With Supraventricular Arrhythmias 2003

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FLUTTER AURICULAIRE FLUTTER AURICULAIRE

  • FLUTTER ISTHMIQUE

ANTIHORAIRE HORAIRE

  • FLUTTER ATYPIQUE

CICATRICIEL AUTRES

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RAO LAO

Ablation cath. Coronary sinus cath. Halo cath. Halo cath. Coronary sinus cath. Ablation cath.

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  • L. C. 541212 (22-11-2000)

RF ON

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RF ON

  • L. C. 541212 (22-11-2000)
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Natale

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Survival rate from recurrent typical atrial flutter (AFl) and atrial fibrillation (AF).

Calkins H et al Am J Cardiol. 2004 Aug 15;94(4):437-42.

N: 150 pts

* * * *

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ACC/AHA/ESC Guidelines for Management of Patients With Supraventricular Arrhythmias 2003

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  • M. Scheinman et al

Pace 2000;23:1020-1028

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FIBRILLATION AURICULAIRE FIBRILLATION AURICULAIRE

  • FA PAROXYSTIQUE
  • FA PERSISTANTE
  • FA PERMANENTE
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Haissaguerre M. et al. NEJM 1998;339:659-66

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Initiation of AF by ectopic beats from pulmonary veins

Haissaguerre M. et al. NEJM 1998;339:659-66

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RAO 30 lAO 40

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RF ON

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RIPV LA RA

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Hakan Oral, MD (Circulation. 2002;105:1077.)

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Oral H

  • Circulation. 2003 Nov 11;108(19):2355-60

FREEDOM FROM RECURRENT PAF AFTER SEGMENTAL OSTIAL ABLATION (SOA, SOLID LINE) AND LEFT ATRIAL CATHETER ABLATION (LACA, DASHED LINE).

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LONG-TERM RESULTS OF RF ABLATION FOR AF : IS IT WORTHWHILE ?

Results :

  • Mean FU: 10.1 M (2- 36)
  • Absence of AF recurrences: 70%

w/o AAD: 31% with AAD: 69%

  • If recurrences: >50% had impressive reduction of AF

episodes.

  • Global improvement: 82%
  • Quality of life (grading scale from 1 to 10 (1 meaning excellent,

10 very bad): score of 7.3 before to 3.4 after ABL.

  • We observed 4.5 % significant PV stenoses.
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FREEDOM FROM RECURRENT AF AFTER INTEGRATED APPROACH (DASHED LINE) AND ANATOMICAL APPROACH (SOLID LINE).

ROBERTO MANTOVAN, M.D. et al Journal of Cardiovascular Electrophysiology 2005

INTEGRATED APPROACH ANATOMICAL APPROACH

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  • R. Cappato et al

Circulation 2005;111:1100-1105

WORLD WIDE SURVEY AF ABLATION

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137 pts 68 69 ABL + AAD AAD

NO RECUR:

91 % 44 %

p: < .001

(FU: 12.5M)

ACC 2005 CACAF study

CATHETER ABLATION FOR CURE OF ATRIAL FIBRILLATION CATHETER ABLATION FOR CURE OF ATRIAL FIBRILLATION

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O Wazni et al. JAMA 2005

RF ABL RF ABL vs vs MED as MED as FIRST LINE FIRST LINE TREATMENT TREATMENT AF RECCURENCES AF RECCURENCES

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CONCLUSIONS CONCLUSIONS

  • L’ABLATION EST UNE TECHNIQUE EXTREMEMENT EFFICACE POUR

LE TRAITEMENT DES ARYTHMIES SUPRAVENTRICULAIRES

  • LES COMPLICATIONS SONT DEVENUES RARES DANS DES MAINS

EXPERIMENTEES

  • LA PLUPART DES ARYTHMIES SV SONT ACTUELLEMENT

CONSIDEREES COMME DES INDICATIONS DE CL I

  • LA FA EST DEVENUE UNE ALTERNATIVE SERIEUSE AU TRAITEMENT

MEDICAMENTEUX MAIS NECESSITE UNE GRANDE EXPERIENCE POUR EVITER CERTAINES COMPLICATIONS DONT L’ INCIDENCE EST ACTUELLEMENT FORTEMENT REDUITE