三维重建房间隔穿刺轨迹技术在射频消融治疗心房颤动中的应用

The application of 3D-reconstruction technique of atrial septum puncture trajectory in radiofrequency catheter ablation for atrial fibrillation

目的探讨三维标测系统重建房间隔穿刺轨迹技术在心房颤动(房颤)射频消融中的安全性及可行性。方法 68例房颤患者在导管消融术中X线透视导引下接受2次穿刺房间隔,Carto 3三维标测系统导引下以快速解剖学标测(FAM)模式实时构建左心房及肺静脉解剖结构,再以FAM模式构建消融导管自左心房经长鞘退入右心房至下腔静脉轨迹。评价导管在该轨迹反复进入左心房是否安全、可行。结果 68例房颤患者通过三维重建房间隔穿刺轨迹,消融导管均可在零X线透视下经右前斜及左前斜体位反复由右心房进入左心房,平均用时(12.18±2.28)s,未出现任何并发症。结论三维标测系统重建房间隔穿刺轨迹技术简易、可行,可安全多次进入左心房,极大地减少房颤导管消融术中X线曝光时间。

Objective To evaluate the safety and feasibility of reconstruction technique of atrial septum puncture trajectory with the help of three-dimensional mapping system in performing radiofrequency catheter ablation for atrial fibrillation. Methods Sixty-eight consecutive patients with atrial fibrillation received two times of atrial septum puncture under fluoroscopic guidance to perform radiofrequency catheter ablation. Carto 3, a three-dimensional mapping system, was employed to construct the real time left atrium and pulmonary vein anatomy by using a rapid anatomical mapping（FAM） model. Then, FAM model was used to construct the trajectory, along which the ablation catheter passed from left atrium through the long sheath to the right atrium and finally into the inferior vena cava. The safety and the feasibility of this catheter trajectory, which could allow the catheter repeatedly enter the left atrium, were evaluated. Results By using 3D-reconstruction technique of atrial septum puncture trajectory, the ablation catheter could repeatedly enter the left atrium at right anterior oblique position as well as at left anterior oblique position under zero X-ray fluoroscopy. The average time spent for the procedure was（12.18 ±2.28） seconds. No any complication occurred. Conclusion The reconstruction technique of atrial septum puncture trajectory with the help of three-dimensional mapping system is simple and feasible, the ablation catheter can repeatedly enter the left atrium, the X-ray exposure time spent for catheter ablation of atrial fibrillation can be greatly reduced.