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

作　　者：徐亚伟[1] 唐恺[1] 马坚[2] 张敬莹[1] 周可[1] 于学靖[1] 陈艳清[1] 

机构地区：[1]上海市第十人民医院心内科,上海市200072 [2]中国医学科学院中国协和医科大学北京阜外心血管病医院心律失常诊治中心

出　　处：《中国介入心脏病学杂志》2007年第4期194-197,共4页Chinese Journal of Interventional Cardiology

摘　　要：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。Objective To study the effect of circumferential pulmonary vein isolation （CPVI） guided by Carto-Merge and Lasso catheter for the treatment of atrial fibrillation （AF）. Methods Fifty-six drug refractory patients （41 male） with paroxysmal AF were enrolled into this study with a mean age of （58. 5 ±12. 7） years. Ostia of pulmonary veins （PVs） were identified by Carto-Merge. Then circumferential pulmonary vein isolation was performed. The endpoint of ablation was abolishment or dissociation of the pulmonary vein potentials （ PVPs ）. Results Mean distance between electroanatomic mapping points and MRI surfaces was （ 1.79 ± 0. 33 ） mm as a whole in this group. Abolishment or dissociation of PVPs was accomplished in 52 patients （92.9%） during the first procedure. After a mean （18.3 ± 5.7） months of follow up, 41 patients （73.2%） maintained sinus rhythm. Ten patients received a second ablation procedure, and 8 were free of atrial tachyarrhythmias after a mean （8.2 ±6. 9） months of the second follow up. No PV stenosls was identified after ablation procedure. Conclusion Combination of Lasso catheters with Carto-Merge to guide the CPVI procedure can confirm the isolation of PVs and lower the incidence of PVs stenosis.

关 键 词：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 

分 类 号：R541.75[医药卫生—心血管疾病]