Διαδερμική Θεραπεία Κολπικής Μαρμαρυγής: Αποτελέσματα και Δεδομένα στην Ελλάδα
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1 Διαδερμική Θεραπεία Κολπικής Μαρμαρυγής: Αποτελέσματα και Δεδομένα στην Ελλάδα Eleftherios M. Kallergis MD, PhD, FESC Cardiology Department Heraklion University Hospital ΠΑΝΕΛΛΗΝΙΑ ΣΕΜΙΝΑΡΙΑ ΟΜΑΔΩΝ ΕΡΓΑΣΙΑΣ 2016
2 Atrial Fibrillation: An Old Acquaintance First described by Sir William Harvey in 17th century: observed chaotic motion of atria in open chest animal ECG findings described in 1909 by Sir Thomas Lewis: irregular or fibrillatory waves and irregular ventricular response or absent atrial activity with grossly irregular ventricular response
3 Still Surrounded by Mystery Sir Thomas Lewis The history of the recognition of fibrillation of the auricles will impress you with the dimness of our eyes and the opacity of the obstacles which embarrass our vision
4 WA Garrey G. Moe JA Abildskov GR Mines
5 The Maze Procedure JL Cox R Schuessler J Boineau Cox JL et al. J Thorac Cardiovasc Surg. 1991
6 AF Ablation: The Surgical Experience Reduction of the atrial tissue mass available for fibrillation is effective in preventing maintenance of AF The left atrium plays a dominant role in maintenance and initiation of AF Limited lesions placed around pulmonary veins may be as effective as complex ablation schema (maze) and safer P. Jaıs et al. Cardiovascular Research 2002
7 1994: Reproduction of Cox Procedure using Catheter Ablation LAA RAA LA Swartz JF IVC The first attempts were made in 1994, by Schwartz in the left atrium Swartz JF et al. Circulation 1994
8 1994: Reproduction of Cox Procedure using Catheter Ablation SVC and Haïssaguerre in the right atrium 1 3 RA 2 T IVC Haïssaguerre M, et al. J Cardiovasc Electrophysiol 1994
9 Technique Extended to Right and Left Atrial Ablation In 1996 Haïssaguerre modified the procedure extending linear lesions to the left atrium Haïssaguerre M, et al. J Cardiovasc Electrophysiol 1996
10 A landmark finding: PV Foci Triggering Afib The pulmonary veins are an important source of ectopic beats, that they are capable of initiating frequent paroxysms of AF, and that they could be eliminated by treatment with radiofrequency ablation Haïssaguerre M, et al. N Engl J Med 1998
11 Circumferential Radiofrequency Ablation of Pulmonary Vein Ostia A New Anatomic Approach for Curing Atrial Fibrillation Circumferential RF lesions are created around the ostia of each PV, with the aim to isolate these veins from the LA while reducing the risk of PV stenosis Pappone C, et al. Circulation 1999
12 Long term Results for AF Ablation A total of 6167 patients were included from 19 studies Ganesan AN et al. J Am Heart Assoc. 2013
13 Catheter Ablation vs. AADs for AF Tung R et al. Circulation. 2012
14 Catheter Ablation vs. AADs for persistent AF SARA study 70.4% of pts were free of sustained episodes of AF in the CA group and 43.7% in the ADT group (P = 0.002) The proportion of pts free of any recurrence of AF or flutter (lasting >30 s) was higher in the CA than that in the ADT group (60.2 vs. 29.2%; P < 0.001) Mont et al. Eur Heart J. 2014
15 Evolution of AF Catheter Ablation The incidence of complications has decreased significantly since the dawn of AF ablation More than 10 years ago, it was around 20% now the global incidence is less than 6% and in experienced centres less than 4% Arrantes L et al. Eur Heart J Suppl 2007
16 AF Ablation in Europe
17 The Atrial Fibrillation Ablation Pilot Study 5 centres 95 patients A prospective, multicentre, observational registry of consecutive patients undergoing a first AFib ablation procedure in 72 Cardiology Centres of 10 European countries Elena Arbelo et al. Eur Heart J 2014
18 The Atrial Fibrillation Ablation Pilot Study Elena Arbelo et al. Eur Heart J 2014
19 The AFib Ablation Pilot Study: Procedural Data ,4 RF irr (%) Cryo (%) Pro dur Rad time Elena Arbelo et al. Eur Heart J 2014
20 The AFib Ablation Pilot Study: Ablation Strategy ,4 21,3 17,9 3,3 PVI (%) Atrial lines (%) CAFEs (%) ganglionated plexi (%) Elena Arbelo et al. Eur Heart J 2014
21 Clinical Symptoms During Follow-up Elena Arbelo et al. Eur Heart J 2014
22 Treatment at Follow-up 64.7% of patients were under some kind of anticoagulant treatment 49% of patients were under antiarrhythmic treatment Elena Arbelo et al. Eur Heart J 2014
23 Outcome of Atrial Fibrillation Ablation Elena Arbelo et al. Eur Heart J 2014
24 AF Ablation in Greece
25 Ablation (%) AF Management in Greece ,6 5,5 4,6 MANAGE-AF Karampli et al EORP-AF
26 Current Situation in Greece 30 Ablation centers/teams (26 hospitals) 8 University 6 NHS 2 Military 2 Semi-Private 8 Private
27 Radiofrequency Ablation Procedures in Greece
28 Demographics Number of patients Number of procedures Age (years) Gender (male/female) % 53.8/ / / / / / /38.7
29
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36 Cryoablation Procedures in Greece
37 Cryoballoon Ablation for AF
38 Cryoballoon Ablation for AF: Baseline Characteristics Gender AF type Paro (%) Pers (%)
39 Type of Catheters
40 Freeze per Vein
41 Procedure Time
42 Radiation Time
43 Recurrence Rates
44 Heraklion Experience
45 Heraklion Experience ,3 26,7 4 RF paroxysmal (%) persistent (%) permanent (%)
46 Heraklion Experience ,01 Pro time Rad time Success rate (%) Relapse rate (%) compli (%)
47 Heraklion Experience Cryo 72,7 paroxysmal (%) 27,3 persistent (%) Pro time Rad time Success rate (%) 0 compli (%)
48 Conclusions Rhythm control for the long-term management of AF is the initial treatment choice of the majority of cardiologists in Greece The percentage of AF patients undergoing invasive treatment in our country is still low AF ablation procedures are performed with high success and low complication rates comparable to the European and US standards
49 Conclusions CA is an important therapeutic modality for AF pts a challenging and complex procedure The progress made and the new developments on the horizon are remarkable In the late 1980s, few would have predicted that CA of AF would emerge as the most commonly performed ablation procedure in most major hospitals
ΚΑΤΑΛΥΣΗ ΚΟΛΠΙΚΗΣ ΜΑΡΜΑΡΥΓΗΣ. ΥΠΕΡ. Michalis Efremidis MD Second Department of Cardiology Evangelismos General Hospital
ΚΑΤΑΛΥΣΗ ΚΟΛΠΙΚΗΣ ΜΑΡΜΑΡΥΓΗΣ. ΥΠΕΡ. Michalis Efremidis MD Second Department of Cardiology Evangelismos General Hospital Rate control versus Rhythm control for Atrial Fibrillation AFFIRM N Engl J Med 2002;347:1825-33
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