CartoMerge 指导下导管消融治疗阵发性房颤初步体会.doc

CartoMerge 指导下导管消融治疗阵发性房颤初步体会 　　【摘要】 目的 运用64排螺旋CT图像与CARTO三维电解剖标测整合技术(Carto-Merge)指导阵发性房颤的导管消融治疗。方法 22 例经抗心律失常药物治疗效果欠佳的患者进行手术, 患者术前1～3 d 行64排CT 心脏成像检查,并将CT 导入有Carto-Merge 的软件包进行三维重建, 重建后在Carto-Merge 指导手术。结果 所有患者均顺利完成手术, Carto-Merge 整合误差为(1. 8 ±0. 62) mm, 使用Carto-Merge 患者平均手术时间为(98 ±28) min,X 线曝光时间为(26 ±11) min。随访1～6 个月,20例均无PAf 发作,2 例发作次数明显减少,所有患者术中术后均无严重并发症。结论 Carto-Merge技术可有效地指导阵发性房颤的射频消融,简化操作, 提高消融手术的成功率。 　　【关键词】 导管消融;CT 心脏成像;心房颤动;图像融合技术 　　 　　Initial experience of catheter ablation in treatment of paroxysmal atrial fibrillation guided by Carto-Merge 　　 　　GAO Yan, LI Yi,LI Shaolong, et al. 　　Department of Cardiology, ST. John’s Heart Hospital of Yunnan, Kunming, Yunnan 650228, China 　　 　　【Abstract】 Objective To investigate the effectiveness and advantages of the Carto-Merge technique in guiding catheter ablation of paroxysmal atrial fibrillation(PAF). Methods Twenty-two patients with drug-refractory PAf were finished 64-slice CT image 1~3 days before ablation. 64-slice CT scan combined with Carto image was performed by using Carto-Merge software and guiding ablation.Results All patients were successfully achieved the endpoint of ablation. Integration error of Caro-Merge was (1. 8 ±0. 62) mm. The mean procedure time was (98 ±28) min in Merge group. The X-ray exposed time was (26 ±11) min in Merge group.During the for 1~6 months,20 patients had no occurance of PAF again and I had less occurane times.All patients had no severe complications. Conclusion Carto-Merge technique can shorten the ablation and X-ray exposed time,also improve safety and effectiveness. 　　【Key words】 Catheter ablation ;CT heart image ;Atrial fibrillation ;Carto-Merge technique 　　 　　作者单位:650228云南省圣约翰心脏病医院心脏内科 　　 　　心房颤动(Af ) 是临床上最常见的难治性心律失常, 而近年来,在三维电解剖标测系统(CARTO)系统指导下肺静脉前庭电学隔离导管消融治疗已成为主要有效治疗策略,对阵发房颤的成功率达87 %[1]。Carto-Merge 是心脏三维标测与CT 影像进行整合的一种技术[2]。由于CT 扫描对心脏的采样点密集,三维重建后的图像接近真实解剖,两者整合产生的融合图像兼具了电学特征和解剖的真实性,弥补Carto 电解剖图像的不足, 帮助术者校正和指导房颤的导管消融,提高准确性和成功率。为探讨运用该技术指导房颤消融的临床疗效与安全性,笔者运用64排C