房颤消融中心腔内超声引导下的房间隔穿刺

Transseptal puncture guided by intracardiac echocardiography (ICE) in the ablation of atrial fibrillation

目的 应用心腔内超声引导房间隔穿刺 ,评价心腔内超声引导房间隔穿刺的安全性与效果。方法 8例阵发性房颤患者 ,电生理检查证实为起源于左心房肺静脉口处的局灶性房颤 ,需要穿刺房间隔。应用经导管心腔内超声观察心脏结构 ,放置超声导管探头于卵圆窝处 ,显示卵圆窝和其周围结构 ,指导房间隔穿刺。扩张器于卵圆窝形成典型的“帐篷状”(Tenting)征象。 8例患者 ,除 2例因术者对超声图像和技术不熟练外 ,其余均一次试穿成功 ,平均时间为 (14 2± 3 5 )min ,无并发症 ,穿刺时间与卵圆窝长度、卵圆窝与左房壁距离呈负相关。结论 心腔内超声能很好显示X线透视下无法直观显示的卵圆窝及其周围结构 ,使穿刺定位更为精确 ,有效地避免并发症 ,是一项很有前途的技术。

Objective To assess the feasibility and safety of intracardiac echocardiography to guide transseptal puncture for the radiofrequency ablation of the left atrial fibrillation Methods and results 8 cases of focal atrial fibrillation originated from the left heart need transseptal puncture Intracardiac echocardiography cather (8 5 F,9 MHz) was utilized to guide transseptal punture The anatomy and relationship of intracardiac and extracardiac structures near fossa ovalis were visualized with ICE The typical tenting of fossa ovalis at the tip of transseptal dilator were observed in all cases Puncture of atrial septum were achieved through fossa ovalis in all cases and a single attempt required in six The mean time of performing transseptal catheferization was (14 2±4 5) minutes There were a negative correlation between the time of performing transseptal catherization and the length of fossa ovalis, and also the distance between the fossa ovalis and the left atrial wall There were no complications Conclusion Intracardiac echocardiography can delineate the structure and relationship around fossa ovalis, which are not identified with X ray exam It is very helpful in determination of the atrial septum puncture and the location of the atrial septum and reducing relative complications