应用旋转成像技术实时重建和融合左心房的三维图像指导心房颤动的导管消融

Reconstructing and registering three-dimensional rotational angiogram of left atrium during ablation of atrial fibrillation

目的研究使用旋转成像技术进行术中实时重建和融合左心房三维图像（3-dimensional rotational angiogram of leftatrium，3DRALA）的可行性和安全性。方法入选46例拟接受导管消融的心房颤动（房颤）患者。全部患者消融术前完成CT扫描，术中进行左心房的旋转成像，完成左心房图像的实时三维重建，并融合到实时X线影像中指导房颤消融。结果3DRALA在44例患者上重建成功，并融合到实时x线影像中；与CT图像相比，肺静脉口直径和左心房容积显示良好的相关性（r≥0．87）。成像中使用的X线剂量，3DRALA明显低于CT图像[（2．7±0．9）mSv和（24．9±3．1）mSv，P〈0．001]。在实时融合的3DRALA图像的导航下，44例患者完成了肺静脉的电隔离。结论应用旋转成像技术实时重建和融合3DRALA，导航房颤的导管消融是安全可行的。

Objective Three-dimensional （3D） image of left atrium （LA） can greatly facilitates ablation of atrial fibrillation （AF）. The 3D image of LA can be intra-procedurally reconstructed by rotational angiography technique. Methods Forty-six patients undergoing AF ablation were included in this study. Pre-procedural CT imaging and intra-procedural reconstructing 3D rotational angiogram of LA （3DRALA） were performed in all the patients. The 3DRALA was reconstructed and registered with the live fluoroscopy. The 3DRA was evaluated in comparison to the CT image. In the navigation of the registered 3DRA,the ablation of AF was performed. Results Forty-four 3DRALAs （95.7%） were successfully reconstructed and registered with the live fluoroscopy. AF ablation was successfully performed in the 44 patients in the navigation of the registered 3DRA. There were good correlations in the PV ostial diameter and the LA volume as assessed by 3DRALA in comparison to CT image （r~〉 0. 87）. The radiation exposure in rotational angiography was substantially less than that in CT scanning [ （2. 7 ± 0. 9）mSv vs （24. 9 ± 3. 1 ） mSv, P 〈 0. 001 3- Conclusions It is feasible to reconstruct and register the 3DRALA with live fluoroscopy using the RVP method during the ablation of AF.