【摘要】 目的 探讨三维影像融合技术指引导管消融治疗心房颤动的意义。方法 入选66例房颤患者,随机分为Carto组(32例)和Carto-Merge组(34例),分别在单独Carto三维标测和Carto-Merge融合CT影像指导下行环肺静脉前庭线性消融,持续性房颤和持久性房颤附加行左房顶部、二尖瓣峡部线和右房三尖瓣峡部线消融,消融终点为环肺静脉彻底隔离,消融线双向阻滞。术后随访18个月。对比两组手术操作R时间、射频消融时间、X线曝光时间、手术并发症,随访后左房容积指数、成功率及房性心律失常复发构成比的差异。进一步将两组中复发、未复发患者分为复发组、未复发组,对比其与左房容积指数的差异。结果 ①两组患者基线资料无明显差异(P>0.05)。②Carto-Merge组肺静脉即时隔离率右侧高于Carto组(79.4%比53.1%),左侧无差异(73.5%比59.4%);射频消融时间[(93.8±17.1)min比(107.3±14.5)min]、X线曝光时间[(36.5±11.6)min比(44.7±12.4)min]、并发症发生率(3.0%比12.5%)均低于CaMo组(P<0.05);平均手术操作时间[(147.5±41.8)min比(165.2±48.6)min],比较无差异(P>0.05)。③随访完成后,两组射频消融成功率(66.7%比62.0%)、复发房性心律失常构成类型比较无明显差异(P>0.05)。治疗前后左房容积指数比较明显降低[Carto(52.7±7.5)ml/m~2比(43.5±8.1)ml/m~2,Carto-Merge(54.1±5.8)ml/m~2比(45.3±6.9)ml/m~2,P<0.05],复发组左房容积指数明显高于未复发组。结论 三维电解剖标测合并CT影像融合在保证房颤射频消融成功率的前提下,提高了手术效率,降低手术并发症,减少X线曝光,尤其对初期开展房颤消融工作渡过学习曲线大有帮助,值得临床射频电生理手术尝试应用。更多还原

【Abstract】 Objective To investigate the influence about Three-dimensional electronatomical mapping with CT image integration on guidance for catheter ablation of atrial fibrillation.Methods Sixty—six atrial fibrillation patiens were randomly divided into two group.Carto group(n=32):underwent circumferential pulmonary vein antrum ablation guided by 3D mapping alone.Carto-Merge group(n=34):underwent circumferential pulmonary vein antrum ablation guided by 3D mapping integratded with CT image.Persistent or Permanent atrial fibrillation patients were performed additional for atrial roof,mitral isthmus line and cavolricuspid isthmus.Endpoint were circumferential pulmonary vein isolation,linear ablation hi-directional electrical isolation,then follow up eighteen months after the procedure.Compared the procedure/radiofrequency ablation/fluoroscopy duration,complication,left atrial volume index,cumulative success rate,and recurrent atrial tachyarrhythmia proportional rate between the two groups.Moreover respectively compared the left atrial volume index between recurrent(re group) and no-recurrent(no-re group) patients in the Carto and Carto-Merge group.Results(l)The baseline clinical material between the two groups were no significant different(P>0.05).(2) Carto-Merge group when compared to Carto group,the real-time isolation rate were higher in right pulmonary vein(79.4%vs 53.1%) and no different in left(73.5%vs 59.4%),radiofrequeney ablation[(93.8±17.1)min vs(107.3±14.5)min]/fluoroscopy duration[(36.5 ±11.6)min vs(44.7±12.4)min],complication rate(3.0%vs 12.5%)were lower(P<0.05),procedure[(147.5±41.8)min vs(165.2±48.6)min]were no different(P>0.05).(3)After twelve months follow up,the cumulative success rate(66.7%vs 62.0%) and recurrent atrial tachyarrhythmia proportional rate between the two groups were no significant different(P>0.05),left atrial volume index were significant decreased than before[Carto(52.7±7.5)ml/m~2vs(43.5±8.1)ml/m~2;Carto-Merge(54.1±5.8)ml/m~2 vs(45.3±6.9)ml/m~2]and were higher in recurrence patients compared with no-recurrence patients[Carto(54.0±6.6)ml/m~2 vs(41.4±5.4)ml/m~2;Carto-Merge(55.5±7.4)ml/m~2 vs(43.8±6.3)ml/m~2].Conclusion Three image integration on guidance for catheter ablation of atrial fibrillation,ensure success rate,highten efficiency,lower fluoroscopy duration and complication rate,are useful to shorten learning curve for initial stage doctors,it deserve to popularize.更多还原