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

作　　者：杜先锋[1] 蒋晨阳[2] 傅国胜[2] 张祖文[2] 孙勇[2] 何红[2] 李长岭[2] 周斌全[2] 鲁端[2] 

机构地区：[1]宁波市第一医院心内科,宁波市315010 [2]浙江大学医学院附属邵逸夫医院心内科浙江大学邵逸夫临床医学研究所

出　　处：《中国介入心脏病学杂志》2008年第1期23-27,共5页Chinese Journal of Interventional Cardiology

摘　　要：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。Objective To compare the clinical efficacy of circumferential pulmonary vein ablation of atrial fibrillation （AF） with and without the assistance of MERGE technique under the guidence of CARTO system. Methods To analyze retrospectively the clinical data of sixty eight patients with AF who consequently underwent radiofrequency catheter ablation from March 2005 to January 2007. Eleven patients （group A） received the ablation under the guidence of CARTO system only while 57 patients （group B） were guided by associated CARTO-MERGE technique. The ablation strategy was to carry out circumferential pulmonary vein isolation first followed by CFAE （Complex Fractionated Atrial Electrograms） ablation in left atrium, liner ablation on the roof, bottom, isthmus of left atrium as well as isthmus of right atrium, the superior vena cava and coronary sinus ablation if necessary. Results The average fluoroscopic duration of group A was 56. 24 ± 13.92min, which was obviously longer than 33.32 ± 13.84 min of group B. After 15.08 ± 1.82- month follow-up, 7 patients （57.14%） in group A did not have recurrence of AF 3 month after the procedure, while in group B, 51 （89. 47% ） patients had no recurrent AF during 8. 97 ± 6. 28- month follow up （P 〈0. 05）. The cure rate of paroxysmal AF in group B was 95. 12%, which was higher than 60% of group A. Two patients in group A required a second ablation because of the recurrence of AF. Three patients with dilated cardiomyopathy and 1 patient with hypertrophic cardiomyopathy in group B showed improvement in heart function after the ablation. Conclusion The procedural success rate and efficacy of circumferential pulmonary vein ablation of AF under the guidance of associated CARTO-MERGE technique is higher than that with CARTO system guidance only. The total fluoroscopic duration could decrease with the help of the merge technique. Serial ablation strategy may improve the efficacy of ablation procedure by modification of the substrate of atrium.

关 键 词：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 

分 类 号：R541.705[医药卫生—心血管疾病] R541.75[医药卫生—内科学]