单纯三维电解剖标测系统指导与图像融合技术辅助下环肺静脉线性消融治疗心房颤动的临床对比分析Clinical comparison of circumferential pulmonary vein ablation of atrial fibrillation with and without the assistance of MERGE technique under the guidence of CARTO system
杜先锋,蒋晨阳,傅国胜,张祖文,孙勇,何红,李长岭,周斌全,鲁端
摘要(Abstract)：
目的评价三维电解剖(Carto)标测系统合并图像融合(Merge)技术指导下行环肺静脉线性消融术治疗心房颤动(房颤)的临床疗效,并与单纯用Carto系统治疗组比较。方法回顾性分析2005年3月至2007年1月间接受导管射频消融术的连续68例房颤患者,其中单纯Carto标测系统指导下手术患者11例(A组),Carto-Merge技术指导下手术患者57例。消融策略:先行左房肺静脉电隔离,必要时加行左房碎裂电位消融+左房顶部、底部、峡部+右房三尖瓣峡部、上腔静脉、冠状静脉窦口部消融。结果A组平均X线透视时间56.24±13.92min,平均随访15.08±1.82个月,7例(57.14%)术后3个月生活质量明显改善,无房颤发作;其中阵发性房颤手术成功率为60%,2例接受第二次消融后治愈。B组平均X线透视时间33.32±13.84min,平均随访8.97±6.28个月,51例(89.47%)术后3个月生活质量明显改善,无房颤发作;其中阵发性房颤手术成功率达95.12%;其X线透视时间,总体及阵发性房颤手术成功率均与A组有明显差异;B组中3例扩张型心肌病和1例肥厚型心肌病房颤消融成功,术后心功能明显改善。结论在Carto-Merge技术指导下行环肺静脉线性消融术治疗房颤能提高手术效率及成功率,进一步减少X线曝光时间。左房肺静脉电隔离+左房碎裂电位消融+左房顶部、底部、峡部+右房三尖瓣峡部、上腔静脉、冠状窦口的消融可能通过改良心房基质而提高房颤手术成功率。
关键词(KeyWords)： 心房颤动;导管消融术;肺静脉;空间电学标测;图像处理,计算机辅助
基金项目(Foundation):
作者(Author): 杜先锋,蒋晨阳,傅国胜,张祖文,孙勇,何红,李长岭,周斌全,鲁端
参考文献(References)：
- [1]Kumagai K.Patterns of activation in human atrial fibrillation.Heart Rhythm,2007,34(3Suppl):7-12.
- [2]Mantovan R,Calzolari V,Cavallini C,et al.Anatomical and electrophysiological approach to atrial fibrillation:technical lim-its.J Cardiovasc Med,2006,7:586-591.
- [3]Jongbloed MR,Bax JJ,Lamb HJ,et al.Multislice computed tomography versus intracardiac echocardiography to evaluate the pulmonary veins before radiofrequency catheter ablation of atrial fibrillation:A head-to-head comparison.J Am Coll Cardiol,2005,45:343-350.
- [4]Jun D,Timm D,Darshan D,et al.Initial experience in the use of integrated electroanatomic mapping with three-dimensional MR/CT images to guide catheter ablation of atrial fibrillation.J Cardiovasc Electrophysiol,2006,17:459-466.
- [5]Sra J,KrumD,Hare J,et al.Feasibility and validation of three-dimensional left atrial models derived from computed tomography with a noncontact cardiac mapping system.Heart Rhythm,2005,2:55-63.
- [6]杨延宗,刘少稳,高连君,等.阵发性心房颤动导管射频消融肺静脉电隔离术的方法学.中华心律失常学杂志,2003,7:315-319.
- [7]Pappone C,Rosanio S,Oreto G,et al.Circumferential radiofre-quency ablation of pulmonary vein ostia:A newapproach for cu-ring atrial fibrillation.Circulation,2000,102:2619-2628.
- [8]Haissaguerre M,Jais P,Shah D C,et al.Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci.Circulation,2000,101:1409-1417.
- [9]张代富,李莹,祁炜罡,等.阵发性心房颤动的三维电解剖标测指导左心房线性消融治疗.中国介入心脏病学,2005,13:219-221.
- [10]Pappone C,Oreto G,Rosanio S,et al.Atrial electroanatomic re-modeling after circumferential radiofrequency pulmonary vein ab-lation:Efficacy of an anatomic approach in a large cohort of pa-tient with atrial fibrillation.Circulation,2001,104:2539-2544.