三维标测系统整合多层螺旋CT图象在房颤射频消融中运用-心血管内科专业论文.docxVIP

上海交通大学医学院 上海交通大学医学院 02 级七年制硕士学位论文 The Use of Integrated Electroanatomic Mapping with Three-Dimensional CT Images to Guide Catheter Ablation of Atrial Fibrillation ABSTRACT Objective Circumferential radiofrequency catheter ablation (RFCA) around the orifices of the pulmonary veins (PV) is a curative catheter-based therapy of paroxysmal, persistent, and permanent atrial fibrillation (AF). The mathematically reconstructed electroanatomic map cannot replicate complex and highly variable PV and LA anatomy. Recently an image integration system (CartoMerge, Biosense Webster Inc., Diamond Bar, CA, USA) which enables integrated electroanatomic mapping with preacquired MR/CT images has been approved for clinical use. It is the purpose of this study to report our initial experience with this novel image integration system to guide catheter ablation of AF. Methods Our study was devided into two parts.In the first part,twenty-one consecutive patients with drug-refractory AF underwent catheter ablation under the guidance of a three-dimensional (3D) electroanatomic mapping system (Carto, BiosenseWebster, Inc., Diamond Bar, CA, USA). Contrast-enhanced high-resolution CT imaging was performed within 1-3 days prior to the ablation procedures. Using a novel software package (CartoMerge, BiosenseWebster, Inc.), the left atrium (LA) with pulmonary veins (PVs) was segmented and extracted for image registration. The segmented 3D CT LA reconstruction was accurately registered to the real-time mapping space with a combination of landmark registration and surface registration. The registered 3D CT LA reconstruction was successfully used to guide deployment of RF applications encircling the PVs. In the second part,thirty-nine patients with symptomatic, drug refractory PAF were assigned to CartoMerge group (n=18, mean age (56.44±8.93) years, history of AF = 5.66years) or CartoXP group (n=21, mean age (53.10±12.39) TM years, history of AF = 4.67 years). Using CartoMerge  Image Integration