应用重叠参考图像技术及CartoMerge技术指导环肺静脉电隔离术治疗阵发性心房颤动的临床体会.pdfVIP

上海医学2010年第33卷第5期 ● ·455· 第十人民医院百年庆典专栏 应用重叠参考图像技术及CartoMerge技术指导 ● 环肺静脉电隔离术治疗阵发性心房颤动的临床体会 唐恺 赵冬冬 张敬莹 陈艳清徐亚伟 【摘要】 目的 报道应用重叠参考图像技术指导的CartoMerge进行环肺静脉电隔离术的结果。方法 在 重叠参考图像技术(将参考图像以反白的形式叠加于透视屏上)的指导下，可准确定位各支肺静脉的顶部及底 部，从中选取解剖点作为CartoMerge的陆标。CartoMerge完成后，重叠参考图像技术又可用于指导消融导管 的定位。结果 本研究入选129例阵发性心房颤动患者均在重叠参考图像技术的指导下成功完成CartoMerge 及导管消融。前40例行标准CartoMerge，三维电解剖标测与CT图像的平均空间差异为(1．42-t-0．67)mm，肺 静脉隔离率为96％，消融操作时间为(92±17)rain，整个手术总耗时(139±32)min。后89例行简化的 CartoMerge，即不用Carto构建完整的左心房模型，而仅选择3～4对陆标进行图像融合操作，手术总耗时进一 步缩短至(115士38)min。结论重叠参考图像技术有助于指导阵发性心房颤动的导管消融，并可有助于规范 陆标的选择。 【关键词】环肺静脉隔离术；重叠参考图像技术；计算机X射线断层扫描；三维电解剖标测；心房颤动 Experience with circumferential pulmonary vein isolation guided by Overlay Ref and CartoMerge for treatment of paroxysmal atrial fibrillation TANG Kai，ZHAO Dongdong，ZHANG Jingying，CHEN Yanqing， XU Yawei．Department of Cardiology，Shanghai Tenth People’s Hospital，Tongji University，Shanghai 200072，China · Corresponding author：XU Yawei．E-mail：doctortangkai@sina．con7．cn [Abstract] Objective To report our initial experience with circumferential pulmonary vein isolation (CPVI)guided by Overlay Ref and CartoMerge for the treatment of paroxysmal atrial fibrillation(PAF)．Methods Totally 129 patients with PAF were enrolled in this study．With Overlay Ref technique，a reference image (inverted)was faded into live fluoroscopic image．Landmarks of CartoMerge were selected from anatomic points of the top of superior pulmonary veins(PVs)and the bottom of inferior PVs guided by Overlay Ref image．Overlay Ref images could also be used to guide the ablation procedure．Results All patients were successfully mapped by CartoMerge guided by Overlay Ref．The first 40 patients received standard CartoMerge procedure．The distance between the mapping points and the CT surfaces was(1．42±0．67)mm for the patients as a whole，leading to a successful rate of 96％for isolation of pulmonary veins．Duration of ablation procedure was(92±17)min，and the total duration of procedure was(139±32)min．Simplified CartoMerge was per