【摘要】 目的对比食管超声(TEE)与多层螺旋CT(MSCT)在房颤导管消融术前左心房血栓筛选中的作用。方法顽固性房颤患者221例。导管消融术前常规TEE和／或MSCT检查除外心房血栓。比较TEE筛选(TEE组,45例)、MSCT筛选(MSCT组,141例)和两种方法均应用患者(T+M组,35例)血栓的阳性检出率,并随访3组患者一过性脑缺血发作(TIA)和脑栓塞的发生率。结果TEE组5例发现左心耳血栓或自发声影(11．1％),MSCT组发现11例(7．80％),T+M组中1例MSCT检测发现左心耳血栓,而TEE未发现,另有2例TEE及MSCT均检测到左心耳血栓(8．57％)。201例患者接受肺静脉节段电隔离或环肺静脉电隔离治疗。在TEE组和MSCT组,各有1例手术过程中出现TIA(2．50％vs 0．78％)。MSCT组中,1例患者术后第2天发生脑栓塞(0．78％)。结论与TEE相比,MSCT对房颤导管消融术前患者心房血栓筛选的敏感度相近,提示MSCT也可以用来进行房颤患者导管消融术前心房血栓的筛选,并可能成为TEE重要的补充性检测方法。更多还原

【Abstract】 Objective To evaluate the ability of the multi slice computed tomography (MSCT) to visualize atrial thrombi before ablation of atrial fibrillation ( AF) compared to transesophageal echocardiography. Methods Two hundred and twenty one patients (45 female, (58±12) years] with 191 paroxysmal AF and 30 persistent AF on an intention to ablation basis were enrolled in this study. To detect atrial thrombi before catheter ablation, TEE, 16-slice spiral CT scanner and both were performed in 45 (group TEE) , 140 (group MSCT) and 35 cases (group Both) , respectively. After that, the routine segmental pulmonary vein isolation or circumferential ipsilateral pulmonary vein ablation were applied as reported elsewhere. The complication of stroke or TIA was observed. Results Atrial thrombus was detected in 5 patients from Group TEE (11. 11% ) and in 11 from Group MSCT (7. 80% ). In Group Both, atrial thrombus was demonstrated by both TEE and MSCT in 2 cases, while in another case the thrombus was detected by MSCT, but not by TEE. These 19 patients were then precluded for further ablation, and anticoagulation drugs were routinely administrated. In 201 patients, catheter ablation was routinely performed. Two patients developed into TIA during ablation procedure, though one has been demonstrated to be thrombus free by TEE (2. 50% ) and the other by MSCT (0. 78% ). In Group MSCT, another patient without thrombus visualized got stroke the day after the ablation (0. 78% ). Conclusion Compared to TEE, MSCT shows similar sensitivity to detect the atrial thrombi in patients with AF, which suggests that MSCT could be an alternative strategy for screening thrombi before catheter ablation.更多还原