CARTO指导下三尖瓣环峡部解剖特征对线性消融的影响  

The anatomy characteristics of cavotricuspid isthmus and its influence on linear ablation navigated by CARTO

作　　者：卢晓峰[1] 陈松文[1] 陈岗[1] 张锋[1] 严轶文[1] 孟伟栋[1] 诸葛萦[1] 刘少稳[1] 

机构地区：[1]上海交通大学附属第一人民医院,上海200080

出　　处：《中国心脏起搏与心电生理杂志》2012年第4期303-306,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨CARTO系统指导下三尖瓣环峡部(CTI)的解剖学特点及其对线性消融的影响。方法接受CTI线性消融的患者,其中典型心房扑动5例、阵发性心房颤动(简称房颤)10例及持续性房颤40例。利用CARTO系统对三尖瓣峡部长度、跨度及最深深度进行测量并根据深度分为囊袋型、凹陷型和平坦型。根据CTI长度将患者分为两组,长组≥35 mm,短组<35 mm。记录CTI消融成功所需时间,同时收集相关临床资料。结果不同类型峡部的长度、跨度、深度及消融所需时间分别为:囊袋型23例(45.5±7.5 mm,38.0±7.4 mm,-9.5±2.8 mm,1707±615 s),凹陷型10例(42.7±9.0 mm,37.2±6.7 mm,-4.2±0.8 mm,1 327±832 s),平坦型22例(36.1±8.9 mm,34.3±8.0 mm,-1.0±3.1 mm,927±404 s)。囊袋型CTI长度、消融时间长于平坦型,囊袋型CTI深度均较平坦型和囊袋型为深(P<0.05)。消融时间与深度正相关(r=0.505,P<0.001)。长组较短组所需消融时间长(1485±681 s vs 803±305 s,P<0.001)。长组以囊袋型为主(48.8%),短组以平坦型为主(78.6%)。结论 CTI线性消融时间与其最深深度相关,峡部越深则消融越费时,囊袋型消融所需时间最多。若CTI长度≥35 mm(更常见于囊袋型CTI),其消融时间则显著延长。Objective To investigate the anatomy characteristics of cavotricuspid isthmus （CTI） and its influence on linear ablation navigated by CARTO in patients with typical atrial flutter （AFL） and atrial fibrillation （AF）. Methods A total of 55 patients （5 typical AFL, 10 paroxysmal AF and 40 persistent AF） , who underwent radiofrequency catheter ablation navigated by CARTO were enrolled in this study. The anatomy characteristics of CTI （length, span and depth） , for classifying the CTI to pouch type, concave type and flat type, were measured and analyzed under the guide of CARTO. The ablation time needed for CTI linear ablation and other baseline characteristics such as gender were also collected for further statistics analysis. Results The length, span, depth and ablation time of different types of CTI were described as followed： pouch type （n =23, 45.5 ±7.5 mm, 38.0 ±7.4 min, -9.5 ±2.8 mm, 1 707 ±615 s,respectively） , con- cave type （ n = 10, 42.7 ± 9.0 mm, 37.2 ± 6.7 mm, - 4.2 ± 0. 8 mm, 1327 ± 832 s, respectively） , and flat type （ n = 22, 36.1 ± 8.9 mm, 34.3 ± 8.0 mm, - 1.0 ± 3.1 mm, 927 ± 404 s, respectively）. The length of CTI in pouch type was significantly longer than that in flat types . The depth of CTI in pouch type was significantly deeper than that in concave and flat types （P 〈 0.05 ）. Correlative analysis showed that there was a positive correlation between the ablation time and the depth of CTI （r = -0.505 ,P 〈0.001 ）. All patients were grouped by the length of CTI to group 1 （less than 35 mm, n = 14） and group 2 （n = 41 ）. The ablation time of group 2 was significant longer than that of group 1 （ 1 485 ± 681 s vs 803 ±305 s, P〈0. 001）. There were more pouch type in group 2 （ 48.8% ） , while the flat type were mainly en- countered in group 1 （78.6%）. Conclusion The ab- lation time of the CTI linear ablation is correlated to the depth of CTI. The ablation time are prolonged in those CTI with length ≥35 mm and most of wh

关 键 词：心血管病学 三尖瓣环峡部 导管消融 射频电流 三维标测 解剖形态 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]