Carto-Merge技术在左肺静脉共干伴阵发性房颤患者导管消融术中的应用  

Application of Carto-Merge technique in catheter ablation of left pulmonary vein common trunk with paroxysmal atrial fibrillation

作　　者：杨森 廖祁伟[1] 李绍龙[1] 何臣德[1] 张彬彬 赵晓华 曾强 光雪峰[1] YANG Sen;LIAO Qiwei;LI Shaolong;HE Chende;ZHANG Binbin;ZHAO Xiaohua;ZENG Qiang;GUANG Xuefeng(Department of Cardiology,Yan'an Hospital Affiliated to Kunming Medical University,Kunming 650051,China;不详)

机构地区：[1]昆明医科大学附属延安医院心内科,昆明650051 [2]昆明医科大学研究生院

出　　处：《山东医药》2023年第11期6-9,共4页Shandong Medical Journal

基　　金：云南省科技厅计划项目(2018IA046);昆明医科大学研究生创新基金资助项目(2022S100)。

摘　　要：目的探讨Carto-Merge技术指导存在左肺静脉共干的阵发性房颤患者行导管消融术的临床效果。方法选择存在左肺静脉共干的阵发性房颤患者27例,随机分为A组13例与B组14例。B组在Carto3技术建立的电解剖标测(FAM)模型指导下进行双侧肺静脉导管消融术,A组在Carto-Merge技术建立的影像融合模型(术前CT三维图像融合Carto3系统指引下建立的FAM模型)指导下进行双侧肺静脉导管消融术。记录并比较A组FAM模型与CT三维图像、B组FAM模型的左肺静脉相关参数(上下径、前后径、开口面积)及左心房容积,比较两组消融环相关参数(消融环上下径、前后径、横截面积、上下径比值、前后径比值及消融环横截面积/左肺静脉开口面积)。两组术后随访6个月,记录消融结局相关指标(双侧肺静脉电隔离完成情况、左右肺静脉消融时间及肺动脉压增高、窦性心律维持情况)。结果A组CT三维图像的左肺静脉开口面积、左心房容积均小于FAM模型(P均<0.05),两组FAM模型的左肺静脉上下径、前后径、开口面积及左心房容积比较差异均无统计学意义(P均>0.05)。A组消融环前后径、横截面积、前后径比值、消融环横截面积/左肺静脉开口面积均大于B组(P均<0.05)。两组消融环上下径、上下径比值及左、右肺静脉消融时间比较差异均无统计学意义(P均>0.05)。两组均顺利完成双侧肺静脉电隔离,其肺动脉压增高率、窦性心律维持率比较差异均无统计学意义(P均>0.05)。结论采用Carto-Merge技术指导存在左肺静脉共干的阵发性房颤患者进行导管消融术时不会增加手术时间,其消融效果与传统Carto3技术相当且安全性较高,有助于复杂肺静脉解剖结构的识别和消融。Objective To investigate the clinical outcomes of the Carto-Merge technique for guiding catheter ablation in patients with paroxysmal atrial fibrillation with left pulmonary vein common trunk.Methods Twenty-seven patients with paroxysmal atrial fibrillation with left pulmonary vein common trunk were selected and randomly divided into the group A of 13 patients and group B of 14 patients.Patients in the group B underwent bilateral pulmonary vein catheter ablation under the guidance of the fast anatomic mapping(FAM)established by the Carto3 technique,while patients in the group A underwent bilateral pulmonary vein catheter ablation under the guidance of the image fusion model established by the Carto-Merge technique(preoperative CT 3D images fused with the FAM model established by the Carto3 system).The left pulmonary vein related parameters(superior-inferior diameter,anterior-posterior diameter,and opening area)and left atrial volume of FAM model and CT model in the group A and FAM model in the group B were recorded and compared.The related parameters of ablation ring(superior-inferior diameter,anterior-posterior diameter,cross-sectional area,ratio of superior-inferior diameter,ratio of anterior and posterior diameter,ratio of cross-sectional area of ablation ring to opening area of left pulmonary vein)were compared between the two groups.The patients in the two groups were followed up for 6 months,and the related indexes of ablation outcomes(completion of electrical isolation of bilateral pulmonary veins,ab-lation time of left and right pulmonary veins,increase of pulmonary artery pressure,and maintenance of sinus rhythm)were recorded.Results In the group A,the left pulmonary vein opening area and left atrial volume in CT three-dimen-sional images were smaller than those in FAM model(both P<0.05).There were no significant differences in the left pul-monary vein superior-inferior diameter,anterior-posterior diameter,opening area or left atrial volume between the two groups in FAM model.The anterior-posterior diame

关 键 词：影像融合 电子计算机断层扫描 电解剖标测 Carto-Merge技术 Carto3技术 导管消融 左肺静脉共干 心房颤动 

分 类 号：R541.7[医药卫生—心血管疾病]