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Clinical, paraclinical characteristics, electrophysiological features, and result of persistent atrial fibrillation ablation with radiofrequency energy

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Tiêu đề Clinical, Paraclinical Characteristics, Electrophysiological Features and Result of Persistent Atrial Fibrillation Ablation with Radiofrequency Energy
Tác giả Vien Hoang Long
Người hướng dẫn Assoc. Prof. Pham Quoc Khanh, Assoc. Prof. Pham Nguyen Son
Trường học Institute of Clinical Medical and Pharmaceutical Sciences
Chuyên ngành Internal Medicine/Internal Cardiology
Thể loại dissertation
Năm xuất bản 2023
Thành phố Hanoi
Định dạng
Số trang 126
Dung lượng 2,64 MB

Cấu trúc

  • 1.1. Diagnosisof atrial fibrillation (18)
    • 1.1.1. Definitionof atrial fibrillation (18)
    • 1.1.2. Diagnosticcriteria foratrial fibrillation (18)
    • 1.1.3. Classificationof AF (19)
  • 1.2. Atrialfibrillation management (20)
    • 1.2.1. ACBpathway (20)
    • 1.2.2. Indicationsforatrialfibrillationcatheterablation (20)
  • 1.3. Recentstudiesaboutatrialfibrillationcatheterablation (21)
    • 1.3.1. OverviewofstudyaboutatrialfibrillationinVietnam (21)
    • 1.3.2. Overviewofstudiesaboutpersistentatrialfibrillationablation (23)
  • 2.1. Subjects (27)
    • 2.1.1. Inclusion criteria (27)
    • 2.1.2. Exclusioncriteria (28)
    • 2.1.3. Diagnosticcriteria usedin thestudy (28)
  • 2.2. Methods (30)
    • 2.2.1. Designand sample size (30)
    • 2.2.2. Datacollection (30)
  • 2.3. Studydata analysis (43)
  • 2.4. Studyethics (43)
  • 3.1. Generalcharacteristicsof thestudy group (45)
    • 3.1.1. Baselinecharacteristics (45)
    • 3.1.2. Ageand sex distribution (45)
    • 3.2.1. Clinicalcharacteristics (47)
    • 3.2.2. Paraclinicalcharacteristics (49)
    • 3.2.3. Electrophysiologicalfeaturesofpersistentatrialfibrillationpatients ......................................................................................................3 7 3.3. Resultsofcatheterablationforpersistentatrialfibrillation (52)
    • 3.3.1. Techniqueindexincatheterablationforpersistentatrialfibrillation ......................................................................................................4 2 3.3.2. Resultwithin24hoursaftercatheterablation (57)
    • 3.3.3. Resultsat1monthfollow-up (60)
    • 3.3.4. Resultsafter3monthsfollow-up (62)
    • 3.3.5. Resultsafter6-monthfollow-up (65)
    • 3.3.6. Theproportionofmaintainingsinusrhythmandclinicalandparaclinical changesafterintervention (66)
    • 3.3.7. Evaluationofsomefactorsrelatedtothesuccessrateofmaintainingsinusrhythmaf terpersistentatrialfibrillationablation (70)
    • 3.3.8. Complicationsofpersistentatrialfibrillationcatheterablation (75)
  • 4.1. Generalcharacteristicsofpatientsinthestudy (76)
  • 4.2. Clinicalandparaclinicalcharacteristicsofpatientsinthestudy (77)
    • 4.2.1. Clinicalcharacteristics (77)
    • 4.2.2. Paraclinicalcharacteristics (78)
    • 4.2.3. Electrophysiologicalfeaturesofpatientsinstudy (80)
  • 4.3. Resultsofpersistentatrialfibrillationcatheterablation (84)
    • 4.3.2. AF-freerateaftercatheterablationforpersistentAF (91)
    • 4.3.3. Somefactorsaffectingthesuccessrateaftercatheterablation forpersistentAF (96)
    • 4.3.4. Safetyofpersistentatrialfibrillationcatheterablation (98)
  • 4.4. Limitations (99)
  • Picture 2.12. No conduction into the left atrium when pacing from the PV1- 2electrode (0)

Nội dung

Diagnosisof atrial fibrillation

Definitionof atrial fibrillation

A supraventricular tachyarrhythmia with uncoordinated atrialelectrical activation and consequently ineffective atrialcontraction.

• Irregularly irregular R-R intervals (when atrioventricularconduction is not impaired), • Absence of distinct repeating Pwaves,and

Symptomatic or asymptomatic AF that is documented bysurfaceECG.

TheminimumdurationofanECGtracingofAFrequiredto establish the diagnosis of clinical AF is at least 30 seconds, orentire12-lead ECG

Diagnosticcriteria foratrial fibrillation

The diagnosis of AF is based on an ECG tracing heart rhythm with nodiscerniblerepeatingPwavesandirregularR-Rintervals.ECGtracingof≥30secondsis diagnosticof clinicalAF [4](Class IB).

Classificationof AF

Firstdiagnosed AFnotdiagnosedbefore,irrespectiveofitsdurationor thepresence/severityofAF-relatedsymptoms.

Persistent AF that is continuously sustained beyond 7 days,includingepisodesterminatedbycardioversion(drugsor electricalcardioversion)after>_7days

Permanent AF that is accepted by the patient and physician, and nofurther attempts to restore/maintain sinus rhythm will beundertaken Permanent AF represents a therapeuticattitude of the patient and physician rather than aninherent pathophysiological attribute of AF, and the termshould not be used in the context of a rhythm controlstrategywith antiarrhythmicdrug therapy or AF ablation Should a rhythm control strategybeadopted,thearrhythmiawouldbereclassifiedas

Atrialfibrillation management

ACBpathway

AccordingtoESCAFguideline2020,thesimpleAtrialfibrillationBetterCare(AB C) wasrecommended forAF management.

B: Better symptom control (choose rhythm control or rate controlstrategy)

Indicationsforatrialfibrillationcatheterablation

Table 1.3: HRS/EHRA/ECAS/APHRS/SOLAECE indications for catheterablation [5]

AFrefractory or intoleranttoatleastoneCl assIorIII antiarrhythmicmedication

Symptomatic AF priorto initiation ofantiarrhythmic therapywith a Class I or

In2020,theEuropeanSocietyofCardiologyissuednewguidelinesontheindication for catheter ablation of AF These guidelines recommend persistentAF ablation in symptomatic patients with low risk of recurrence and failure ofmedicaltherapy asa classI recommendation[3].

Recentstudiesaboutatrialfibrillationcatheterablation

OverviewofstudyaboutatrialfibrillationinVietnam

- Tuan N.X (2013) reported arrhythmias after cardiac surgery at HanoiHeart Hospital: the highest rate of AF after coronary surgery, accounting for56.25%,aftersurgery,valvularheartdiseasewas20.9%,whileaftercongenitalheartsurge ry this rateis only 9.52%[6]

- ToanN.D,OanhN.OandHieuN.L(2015)conductedastudytoinvestigate the rate of

AF in patients with heart failure and recorded the resultup to 27.2% (in 213 patients), this rate tends to be higher in the group of patientswithreducedleftventricularfunction

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