影像融合系统指导下导管消融伴双下肺静脉共同开口的心房颤动特点

Characteristics of image integration system guiding catheter ablation of atrial fibrillation with a conunon ostium of inferior pulmonary veins

目的探讨影像融合系统指导下导管消融伴双下肺静脉共同开口的心房颤动（房颤）的解剖学、电生理学和治疗学特点。方法1381例药物治疗无效的房颤患者在消融前接受磁共振血管造影或多排CT扫描，影像融合技术（CartoMerge^TM software）重建左心房和肺静脉。阵发性房颤者进行了触发灶的电生理标测。基本消融策略是在影像融合系统指导下“三环法”肺静脉隔离：两个环分别围绕两个上肺静脉，另一个环围绕双下肺静脉共同开口。结果影像融合系统成功重建1381例左心房和肺静脉并发现有12例（0．8％）为左、右下肺静脉共同开口，这种变异可分为两种形态：没有短共干的Ⅰ型双下肺静脉共同开口和有短共干的Ⅱ型双下肺静脉共同开口。多数阵发性房颤在共同开口内有触发灶。“三环法”肺静脉隔离术成功率83％。结论双下肺静脉共同开口可按有无短共干分为两型。共同开口内可能是阵发性房颤的重要病灶。在影像融合技术指导下进行“三环法”肺静脉隔离的消融策略可能是伴该种肺静脉变异的房颤患者较好的治疗方法。

Objective To investigate the anatomic, electrophysiological and therapeutic characteristics of catheter ablation of atrial fibrillation （AF） with a common ostium of inferior pulmonary veins （PVs） under the guidance of image integration system. Methods A total of 1381 patients with drug-refractory AF received magnetic resonance angiography （MRA） or muhidetector computed tomography （MDCT） scan and LA and PVs reconstruction by image integration system （CartoMerge^TM software）before ablation. Electrophysiological mapping was used to detect the focal triggers in paroxymal AF. Basic catheter ablation strategy was circumferential PV isolation with ＂triple circles＂ under the guidance of image integration system ： two circles surrounding two superior PVs and the third surrounding the common ostium. Results LA and PVs reconstruction by image integration system showed a common pulmonary venous ostium of the right and left inferior PVs before ablation in 12 patients （0.8%）, This anomaly could be classified into two types ： typeIwithout a short common trunk of inferior PVs and typell with a short common trunk. Most of paroxymal AF was revealed of focal triggers in the common ostium. The success rate of that strategy was 83%. Conclusion Common ostium of inferior PVs could be classified into two types according to presence of a short common trunk or not. The common ostium is an important triggering focus in paroxymal AF. Catheter ablation strategy of circumferential PV isolation with ＂triple circles＂ under the guidance of image integration system in patients with that anomaly may be a good choice.