64层螺旋CT左心房和肺静脉成像在心房颤动射频消融术中的价值及应用

The application and value of 64 multislice spiral CT of left atrium and pulmonary vein in radiofrequency ablation of atrial fibrillation

目的应用64层螺旋CT（MSCT）对左心房和肺静脉进行形态学分析，用以指导心房颤动（简称房颤）环肺静脉线性消融术，并评估预后。方法对232例患者（房颤组146例，对照组86例）行64层MSCT左心房和肺静脉成像，比较房颤组及对照组肺静脉解剖学变异的发生率，测量各支肺静脉开口的径线及形态，观察左心房的大小及左心房耳部的形态。结果64层MSCT左心房和肺静脉成像可以提供详细的左心房与肺静脉连接方式及肺静脉解剖学变异，肺静脉解剖变异占总样本数的16．8％（39／232）。各组肺静脉开口均呈上下径大于前后径的椭圆形。房颤组及对照组中左心房的内径差异存在统计学意义[房颤组：（39．47±8．98）mm；对照组：（36．94±5．49）mm；P=0．02]，而2组患者肺静脉开口的径线差异无统计学意义[房颤组肺静脉上下径：左上（18．15±1．35）mm，左下（16．96±1．18）mm，右上（17．50±1．12）mm，右下（17．65±0．94）mm；对照组肺静脉上下径：左上（18．07±0．94）mm，左下（17．50±0．57）mm，右上（18．03±1．02）mm，右下（17．94±0．76）mm，P值均〉0．05；房颤组肺静脉前后径：左上（12．26±1．89）mm，左下（11．96±0．61）mm，右上（12．32±1．08）mm，右下（12．39±0．95）mm；对照组肺静脉前后径：左上（12．74±1．03）mm，左下（12．23±0．75）mm，右上（12．64±0．87）mm，右下（12．72±0．67）mm，P值均〉0．05]。结论64层MSCT左心房和肺静脉成像不仅可以了解环肺静脉线性消融术前肺静脉及左心房解剖变异的情况，而且可以进一步评价心房功能和风险，对介入治疗具有重要的指导意义。

Objective Analyzing the left atrium and pulmonary vein morphologically by 64 muhislice spiral CT （MSCT） scan to guide the catheter ablation of Atrial fibrillation. Methods Two hundred and thirty-two patients （146 cases in atrial fibrillation group and 86 cases in control group） received 64 MSCT examination of the left atrium and pulmonary vein. The incidence of anatomical variation of pulmonary vein was compared between atrial fibrillation group and control group. For each group, the anatomical morphology of every pulmonary vein and the auricle of left atrium was analyzed, the diameter of the orifice of each pulmonary vein and the size of left atrium were measured. Results Sixty-four MSCT of left atrium and pulmonary vein could demonstrate detailed connecting type between left atrium and pulmonary veins and the possible anatomical variation. Anatomical variation of pulmonary vein in this study accounted for 16. 8% （39/232） of total sample. For both groups, orifices of pulmonary veins appeared oval and their superoinferior diameters were larger than their anteroposterior diameters. There was significant difference in the inner diameter of left atrium between atrial fibrillation group and control group [ atrial fibrillation group ： （39.47 ± 8.98） mm, control group ： （ 36.94 ± 5.49 ） mm, P = 0.02], while there was no difference in the diameters of orifices of pulmonary veins between two groups [ superoinferior diameters of pulmonary veins in atrial fibrillation group： left-up （ 18.15 ± 1.35 ） mm, left-down （ 16.96± 1.18 ） mm, right-up （ 17. 50 ±1.12）mm, right-down （ 17.65 ±0. 94） mm, superoinferior diameters of pulmonary veins in control group： left-up （ 18.07 ± 0. 94 ） mm, left-down （ 17.50 ± 0. 57 ） mm, right-up （ 18.03 ± 1.02 ） mm, right-down （ 17.94± 0.76 ） mm, the corresponding P 〉 0. 05, respectively, anteroposterior diameters of pulmonary veins in atrial fibrillation group： left-up （ 12. 26 ±1.89） mm, left-down （ 11.96 ±0. 61 ） mm, right-up （ 12. 32 ±1.08）mm,right-down （12.39 ±0. 95） mm, anteroposterior diameters of pulmonary veins in control group： left-up （ 12. 74 ± 1.03 ） mm, left-down （ 12. 23±0.75 ） mm, right-up （ 12. 64± 0. 87 ） mm, right-down （12.72±0.67） mm, the corresponding P 〉0.05]. Conclusions Sixty-four MSCT of left atrium and pulmonary vein is an efficient way of showing anatomical variation of pulmonary vein and left atrium prior to circumferential pulmonary vein ablation. Various morphological findings acquired from this study are important information for interventional therapy.