三维电解剖标测系统结合肺静脉前庭电位指导心房颤动经导管消融

Catheter ablation guided by three-dimensional electroanatomic mapping system in combination with pulmonary vein antrum potential in patients with atrial fibrillation

背景:目前常用的肺静脉前庭定位手段主要是通过三维电解剖标测(CARTO)结合X射线影像或CT影像融合等完成,这些方法均是通过解剖指导进行肺静脉前庭定位、消融,消融是否命中心房颤动(房颤)赖以维持的关键部位不得而知。目的:验证三维电解剖标测系统结合肺静脉前庭电位指导房颤经导管消融治疗的可行性。设计、时间及地点:验证性临床试验,于2007-03/2009-06在济南市第四医院及河北省人民医院心内科完成。对象:纳入药物治疗无效的症状性阵发性房颤患者51例。方法:于CARTO标测系统结合肺静脉前庭电位标测指导下行环肺静脉前庭线性消融,消融终点为肺静脉隔离,观察操作相关参数及消融成功率。主要观察指标:观察手术操作时间、X射线照射时间、手术成功率及并发症等操作相关参数。结果:51例患者均实现消融终点。平均操作时间(207±36.7)min,透视时间(38.2±14.3)min,消融时间(56.4±15.7)min。经过(17.5±3.8)个月的随访,累计40例(78.4%)无房颤、心房扑动及房性心动过速等心律失常发生。无严重操作相关并发症发生。结论:肺静脉前庭电位标测有助于肺静脉前庭的解剖定位,结合三维电解剖系统指导房颤消融效果好,安全性高,方法可行。

BACKGROUND： Presently used pulmonary vein antrum location methods mainly performed by three-dimensional electroanatomy combined with X-ray image or CT image fusion. These methods conducted vein antrum location and ablation by anatomy instructions. It is still poorly understood whether the ablation hit the key part of atrial fibrillation. OBJECTIVE： To explore the feasibility of catheter ablation guided by three-dimensional electroanatomic mapping system in conjunct with pulmonary vein antrum potential in patients with atrial fibrillation . DESIGN, TIME AND SETTING： The verification clinical study was performed at the Department of Cardiology of Jinan Fourth People＇s Hospital and Hebei People’s Hospital from March 2007 to June 2009. PARTICIPANTS： Fifty-one patients with drugs refractory, paroxysmal atrial fibrillation were included. METHODS： All patients underwent circumferential pulmonary vein antrum ablation guided by three-dimensional electroanatomic mapping system （CARTO） in conjunct with pulmonary vein antrum potential with the endpoint of electrical isolation. Relevant parameters and ablation success rate were observed. MAIN OUTCOME MEASURES： Procedure-related parameters, such as procedure duration, fluoroscopy duration, cumulative success rate and complication were observed. RESULTS： Pulmonary veins were isolated in all 51 patients. The mean procedure duration, fluoroscopy time and radiofrequency ablation duration are respectively （207±36.7） minutes, （38.2±14.3） minutes, （56.4±15.7） minutes. After （17.5±3.8）-months follow-up, forty （78.4%） patients did not have recurrence of atrial fibrillation, atrial flutter or atrial tachycardia. No severe procedure-related complication had happened. CONCLUSION： Pulmonary vein antrum potential can be used as a landmark to define pulmonary vein antrum, that combined with CARTO system to guide pulmonary vein antrum ablation is effective, safety and feasible for catheter ablation of atrial fibrillation.