联合应用磁共振扫描与三维电解剖标测系统图像融合技术及Lasso导管标测技术指导环肺静脉隔离治疗心房颤动Circumferential pulmonary vein isolation guided by Carto-Merge and Lasso catheters for the treatment of atrial fibrillation
徐亚伟,唐恺,马坚,张敬莹,周可,于学靖,陈艳清
摘要(Abstract)：
目的报道联合应用三维电解剖标测系统图像融合技术(Carto-Merge)及Lasso导管标测技术指导环肺静脉电隔离术治疗心房颤动(房颤)的结果。方法共入选56例症状明显、药物治疗无效的阵发性房颤患者,男性41例,女性15例,平均年龄58·5±12·7岁。应用Carto-Merge技术定位肺静脉口,之后环双侧肺静脉前庭线形消融左心房,终点为Lasso导管所标测的同侧肺静脉电位消失或肺静脉电位与心房电活动的分离。结果全组患者的电解剖标测点与影像图像(MRI)的空间差距均值1·79±0·33mm。首次手术的肺静脉隔离率为92·9%(52/56)。经随访18·3±5·7个月,有73·2%的患者(41/56)仍维持窦性心律。10例患者接受再次消融;经再次随访8·2±6·9个月,8位患者仍维持窦性心律。无一例患者出现肺静脉狭窄。结论联合应用Carto-Merge及Lasso导管标测技术,可有效地确保肺静脉的隔离,降低肺静脉狭窄等并发症的发生率。
关键词(KeyWords)： 心房颤动;导管消融术;肺静脉;磁共振成像;图像处理,计算机辅助;空间电学标测
基金项目(Foundation):
作者(Author): 徐亚伟,唐恺,马坚,张敬莹,周可,于学靖,陈艳清
参考文献(References)：
- [1]Ouyang F,Bansch D,Ernst S,et al.Complete isolation of left atrium surrounding the pulmonary veins.New insights from the double-lasso technique in paroxysmal atrial fibrillation.Circulation,2004,110:2090-2096.
- [2]Tops LF,Bax JJ,Zeppenfeld K,et al.Fusion of multislice computed tomography imaging with three-dimensional electroanatomic mapping to guide radiofrequency catheter ablation procedures.Heart Rhythm,2005,21076-1081.
- [3]Tang K,Ma J,Ma FS,et al.Initial experience with circumferential pulmonary vein ablation guided by fusion of magnetic resonance imaging with three-dimensional electroanatomic mapping.Chinese Medical Journal,2006,119:1047-1052.
- [4]Ernst S,Ouyang F,Lober F,et al.Catheter-induced linear lesion in the left atrium in patients with atrial fibrillation.J Am Coll Cardiol,2003,42:1271-1282.
- [5]Dickfeld T,Calkins H,Zviman M,et al.Anatomic stereotactic catheter ablation on three-dimensional magnetic resonance images in real time.Circulation,2003,108:2407-2413.