心腔内三维超声辅助下经导管射频消融心房颤动的初步体验  

Radiofrequency ablation for atrial fibrillation guided by intracardiac echocardiography with Carto- Sound system

作　　者：刘俊[1] 贾玉和[1] 王志民 马瑞芳 许保红[4] 田瑞国[1] 唐闽[1] 张竞涛[1] 方丕华[1] 张澍[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心心血管疾病国家重点实验室阜外医院心律失常中心,100037 [2]中国医学科学院超声科,100037 [3]山西省运城市第一医院心内科 [4]山西省太原市中心医院心内科

出　　处：《中华心律失常学杂志》2016年第1期45-48,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的采用心腔内三维超声导管（SoundStar）联合专用三维电解剖标测系统（CartoSound）进行射频消融治疗心房颤动（房颤）的初步经验。方法2015年01月阜外医院采用该技术为3例阵发性房颤患者完成房颤消融手术。局部麻醉下经左侧股静脉途径放置Sounstar导管，建立左心房及毗邻解剖结构、指导房间隔穿刺和导管消融。经右侧股静脉途径放置标测导管和消融导管到左心房，进行双侧环肺静脉电隔离消融。合并典型房扑患者进行三尖瓣峡部线性消融。术后3个月行24h动态心电图检查评判消融治疗效果。结果3例患者均顺利应用心腔内三维超声导管技术完成射频消融手术。术中及术后均无心包积液、心脏压塞、心房内血栓形成、腹股沟血肿等严重并发症。手术时间分别为130min（首例）、120min（包括三尖瓣峡部消融术）和130min（包括三尖瓣峡部消融术）；X线曝光时间分别为5、6和5min。术后3个月动态心电图随访均未见心房扑动（房扑）／房颤／房性心动过速（房速）发作。结论利用心腔内三维超声导管联合专用三维电解剖标测系统进行房颤消融手术安全有效、定位准确、无需造影剂、x线曝光时间明显减少。Objective We reported the initial experience in the three cases with radiofrequency abla- tion for atrial fibrillation （AF） guided by a new technology of SoundStar catheter with intraeardiae echoeardio- graphy and CartoSound system. Methods Three patients with atrial fibrillation were received the CartoSound- guided ablation in Fuwai hospital under the local anesthesia. The Sounstar catheter was inserted from left femo- ral vein to guide the anatomical reconstruction of left atrium and its adjacent structures, the transseptal puncture the eatheter ablation. The mapping and ablation catheter were inserted into left atrium and the bilateral pulmo- nary vein isolation were arehived. The tricuspid isthmus ablation line was added for the patients with typical at- rial flutter. The 24 h Hoher test was applied to detect the atrial arrhythmia and to evaluate the ablation effect. Results The new technology was successful in all the three patients.There were no serious complications inclu- ding pericardial effusion, cardiac tamponade,thrombogenesis in cardiac chambers,groin hematoma during or af- ter ablation.The operation procedure time was 130 min（ in the first case）, 120 min（ in the second case with ad- ditional eavo-trieuspid isthmus ablation）and 130 rain（ in the third ease with additional eavo-tricuspid isthmus ablation）, successively.The X ray exposed time was 5,6, and 5 min, respectively.All the patients were free from AF, atrial flutter, or atrial taehycardia after 3 months during Hoher mintoring. Conclusion Our initial experiences showed that this new technology can be used for AF ablation with many profiles of safety,effectivity, precise po- sition, and without contrast agent and lower X ray exposure.

关 键 词：心房颤动 射频消融 心腔内三维超声 三维电解剖标测 

分 类 号：R541.75[医药卫生—心血管疾病]