应用64排CT图像整合Carto系统进行心房颤动导管消融

Application of integrating 64-slice CT image and the CARTO system in catheter ablation of atrial fibrillation

目的应用64排CT图像与三维电解剖标测整合技术(Carto-Merge)指导心房颤动(房颤)导管消融。方法15例对药物治疗无效的房颤患者,术前1～3d行64排CT成像检查,然后应用新型的Carto-Merge软件包,将64排CT获得的图像导入三维电解剖标测系统(Carto)中,分离并重建左心房及肺静脉CT图像,应用Carto-Merge软件,陆标匹配(Landmark Match)+表面匹配(Surface Match)法将左心房及肺静脉的CT图像与电解剖标测成像进行整合,在整合重建图上指导环肺静脉隔离消融房颤。结果所有患者的CT图像均能与电解剖标测图像进行整合,并可指导房颤的导管消融,整合误差为2·11±0·82mm。完成环肺静脉消融治疗后,30对肺静脉全部实现电隔离;手术时间平均为170·51±38·47min。心脏压塞并发症1例,随访3个月后15例均无房颤复发。其中包括2例服用抗心律失常药物的持续性房颤患者,所有患者均无血栓及肺静脉狭窄并发症。结论64排CT图像整合Carto系统的方法有助于成功进行房颤的导管消融治疗。

Objective To explore the application of integrating （M-slice CT image with threedimensional electroanatomic mapping（Carto-Merge） in guiding catheter ablation of atrial fibrillation （AF）. Methods Fifteen patients with drug-refractory AF received catheter ablation of AF. 64-slice CT scan was performed 1 -3 days prior to the ablation procedures. Using a novel software package, the left atrium （LA） with PVs was segmented and extracted for image registration with a combination of landmark registration and surface registration. Results The integration of the CT image into the electroanatomic mapping system was performed successfully in all patients with an error of 2. 11±0. 82 mm. Thirty pairs of PVs were electrically isolated after circumferential rediogrequency pulmorary rein ablation. The mean procedure time was 170. 51±38.47 minutes. Cardiac tamponade occurred in one patient. All the fifteen patients were free of AF recurrence after 3 months of follow up including the 2 cases of persistent AF who required antiarrhythmic drugs. No thromboembolic events or stenosis were observed. Conclusion Integration of （M-slice CT image into the CARTO system successfully performed in patients undergoing catheter ablation of AF and enhance the ablation success rate.