根据冠状窦电极走行个体化选择房间隔穿刺时右前斜位透视角度的应用体会

The experience of puncturing atrial septum under the right anterior ablique projection with an angle individually selected according to the shape of coronary sinus electrode

目的总结在行房间隔穿刺时根据冠状窦电极走行特征个体化选择右前斜位透视角度的实际应用体会。方法选择50例因接受房颤导管消融手术而需行房间隔穿刺的患者为研究对象。每例均先经左侧或右侧锁骨下静脉放置冠状窦电极，在后前位透视下，将房间隔穿刺针及长鞘管从上腔静脉回撤至冠状窦口上方1．0～1．5个椎体高度，然后在右前斜位透视下完成穿刺。右前斜位透视角度根据冠状窦电极走行特征选择。记录每例穿刺时的透视角度。结果50例均顺利完成房间隔穿刺，无并发症发生。穿刺时右前斜位透视角度为（35．5±87．21）°，其中多数病例（33例，66％）透视角度为25°～35°。透视角度与左房内径呈弱负相关（P=-0．055，r=-0．27）。结论根据冠状窦电极走行选择房间隔穿刺时的右前斜位透视角度，可以更好地展示房间隔平面，有利于穿刺点准确定位，提高穿刺的成功率及安全性。

Objective To sum up the experience of individually selecting the angle of right anterior oblique（RAO） projection according to the shape of the coronary sinus （CS） electrode when an atrial septal puncture was performed. Methods 50 patients who underwent the catheter ablation of atrial fibrillation were involved in this study. For each patient, a 10-pole electrode catheter was sent into the CS through the left or right subclavian vein. Under the poster-anterior projection, the puncture needle along with the Swartz long sheath were with- drawed from the superior vena cava to the level of 1.0 to 1.5 vertebrae higher than the ostium of CS. Then the puncture was completed under the RAO projection. The projecting angle was selected based on observing the shape of CS electrode. The degree of the projecting angle was recorded for each patient. Results Atrial punctures were performed successfully for all patients and no complications occurred. The mean angle of RAO projection when the puncture completed was （5.58＋7.21） degree. For most patients（33, 66%）, the projecting angle was between 25 to 35 degree. The correlation analysis indicated that the angle of RAO projection was weak negatively correlated with the left atria diameter （P=0.055,r=-0.27）. Conclusion Under the RAO projection with an angle selected according to the shape of CS electrode, the plane of atrial septum could be showed clearly and the puncture point located exactly. Therefore, the success rate and safety might be improved.