三维电解剖标测系统联合CT影像融合技术指导心房颤动环肺静脉电隔离术的临床研究

Clinical research of the circumferential pulmonary vein isolation for atrial fibrillation guided by the three-dimensional (3D) electroanatomic mapping system and CT imaging

目的探讨和比较新型三维电解剖标测系统(CARTO3)及CT影像融合技术(CARTO-Merge)指导阵发性心房颤动与持续性心房颤动环肺静脉电隔离术(CPVI)的有效性和安全性。方法 52例经药物治疗无效且有房颤症状患者分为阵发性房颤组24例(A组)与持续性房颤组28例(B组)。将术前16排心脏CT扫描数据与CARTO3系统快速解剖标测重建三维解剖图形进行CARTO-Merge融合,指导CPVI,终点为消除所有肺静脉电位,未转律者行直流电复律。结果所有患者用环状标测导管Lasso建模,A组与B组间肺静脉前庭平均直径、平均手术总时间及平均冷盐水输入量差异均有统计学意义(均<0.05);两组CARTO三维消融靶点图与CT三维解剖图的平均距离、平均融合时间、平均X线曝光及消融时间差异均无统计学意义(均>0.05)。A组18例(75%)与B组14例(50%)患者消融转为窦律,两组均未发生严重并发症。结论 CARTO3及CARTO-Merge指导房颤CPVI具有较好的有效性与安全性。

Objective To investigate and compare the safety and efficacy of circumferential pulmonary vein isolation（CPVI） of paroxysmal atrial fibrillation（PAF） and persistent atrial fibrillation（PeAF） guided with neotype 3D electroanatomic mapping system（CARTO 3） and integration of the CT imaging image into the CARTO 3（CARTOMerge）.Methods Fifty-two atrial fibrillation（AF） patients with drug refractory and symptomatic were enrolled.Patients were divided into two groups： 24 PAF patients（group A） and 28 PeAF（group B）.Patients underwent CPVI using the Carto-Merge,which was the integration of the image obtained using CT imported into 3D electroanatomic map recostructed by fast anatamica mapping（FAM） with CARTO3.The procedural end point of the ablation strategie was complete the electric isolation of all the pulmonary vein potentials.If AF persisted,electrical conversion was performed.Results 3D electroanatomic map recostructed with a circular mapping catheter（Lasso） in 52 patients.The larger diameter of pulmonary vein ostia,longer total procedural time and more periprocedural net fluid were found in the patients of group B compared with those in group A（P0.05）.There were no difference in the mean registration time of CARTO-Merge,mean distance of Cartomerge lesions to the 3D anatomic CT shell between two groups（P0.05）.In 18 patients（75%） in group A and 14 patients（50%） in group B with CPVI resulted in restoration of sinus rhythm（P=0.04）.No major complications have been observed in these patients during the procedures.Conclusions The ablation stratery as CPVI for AF patients guided by CARTO-Merge is safe and effective.