房颤消融径线及其与周围结构的解剖关系分析-analysis of ablation path of atrial fibrillation and its anatomical relationship with surrounding structures.docxVIP

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房颤消融径线及其与周围结构的解剖关系分析-analysis of ablation path of atrial fibrillation and its anatomical relationship with surrounding structures.docx

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房颤消融径线及其与周围结构的解剖关系分析-analysis of ablation path of atrial fibrillation and its anatomical relationship with surrounding structures

3. 左房顶部左侧以及左上肺静脉近心房段与食管前壁相邻，这些部位的消融损伤食管的可能性大。左房前后径大于 40mm 的房颤患者的左房顶部或左上肺静脉更接近食管前壁。 4. 大部分患者的上肺静脉与肺动脉、支气管直接相邻。在进行左上肺静脉口内的消融时，距肺静脉口距离20.7～31.4mm时容易损伤支气管或肺动脉，而在右上肺静脉口内消融时，距离肺静脉口距离14.8～22.3mm 时容易造成支气管或肺动脉的损伤。 5. 二尖瓣峡部线的中段以及近二尖瓣环段的消融可能损伤左回旋支和心大静脉，但左回旋支其较心大静脉距离二尖瓣峡部更远。少数变异的右冠状动脉接近二尖瓣峡部，但损伤的可能性很小。 6.四个肺静脉口的最大及最小径线均具有较大差异，右侧肺静脉口直径大于左侧肺静脉，上肺静脉口直径大于下肺静脉。行大小不同的双 Lasso指导下的环肺静脉消融更为合理。部分患者的LIPV口形态扁平，建议选择形态可控的多极导管进行肺静脉电位标测。 7. 持续性房颤患者的左房径线大于阵发性房颤患者，左房的扩大同时造成肺静脉消融环周长以及顶部消融线的延长。关键词心房颤动，双源 CT，线性消融，并发症，解剖关系 ABLATION LINES OF ATRIAL FIBRILLATION AND THEIR ANATOMIC RELATIONSHIP WITH NEARBY STRUCTURES ABSTRACT OBJECTIVE: Analyze the anatomic relationship between roofline or mitral isthmus ablation lines and nearby structures of atrial fibrillation (AF) patients, evaluate the alternate of mitral isthmus ablation line and provide imaging reference for linear ablation of AF. METHOD: The study population consisted of 58 AF patients with an average age of 64±9 years among whom there were 41 paroxysmal AF patients(average age of 64±9 years) and 17 persistent AF patients(average age of 63±10 years). All subjects underwent cardiac DSCT examination one week before ablation procedure. Syngo workstation and 3-dimension electroanatomic mapping system CARTO were used to make reconstruction and measurement of left atrium (LA), pulmonary veins (PV) and the nearby structures. Parameters measured included diameters of LA, PA ostia, length of ablation lines and distance between linear ablation lines and esophagus, bronchus, pulmonary artery, coronary arteries and veins. Circumferential PV ablation line was a smooth circle around the ipsilateral superior and inferior PVs that was 5mm away from the PV or antrum ostia. Roofline connected the most superior point of two circles. Two different mitral isthmus ablation lines were defined. Line 1 was the shortest line connecting the most inferior point of LIPV ostium and MA; line 2 was the shortest line connecting MA and the middle point of the anterio