三维标测系统指导下行三维房间隔穿刺术的应用体会

Clinical application of three-dimensional atrial septal puncture guided by CARTO3

目的探讨三维标测系统(CARTO3)下行三维房间隔穿刺术的安全性和有效性。方法 23例经三维房间隔穿刺行射频消融术的心律失常患者在CARTO3三维标测系统引导下,用冷盐水灌注压力消融导管(ABL)或pentary标测电极以快速解剖学标测(FAM)模式构建右心房,标记出三尖瓣环、希氏束(HIS)、右心房间隔面、卵园窝和冠状窦(CS)等重要解剖结构。利用电极在CARTO3系统显影的原理,将房间隔穿刺针尾端通过尾线与CARTO3主机相连,使得房间隔穿刺针头端在三维重建的心脏解剖中显影。在左前斜45°(LAO 45°)和左前斜135°(LAO 135°)两个体位下进行1次三维房间隔穿刺术,评价三维房间隔穿刺术在临床应用中的的可行性和安全性。结果 23例患者均在三维标测系统下清晰地构建了右心房模型及重要的解剖结构,并在此基础上成功进行了房间隔穿刺。右心房重建时间为(18.5±5.6)min,房间隔穿刺时间为(7.6±2.1) min,卵园窝标出率和穿刺成功率均为100.0%,射线曝光时间为0 min,心包填塞并发症为0例。结论三维房间隔穿刺术安全、直观、可靠,可有效减少房间隔穿刺过程中的射线损伤。

Objective To evaluate the safety and effectiveness of three-dimensional (3-D) atrial septal puncture (ASP) guided by CARTO3.Methods 23 patients with arrhythmia underwent radiofrequency ablation via 3-D atrial septum puncture. Under the guidance of CARTO3 three-dimensional mapping system,the right atrium was constructed by using cold saline perfusion pressure ablation catheter (ABL) or pentary mapping electrode in a fast anatomical mapping (FAM) mode,and the important anatomical structures such as tricuspid annulus,hirschner bundle (HIS),right atrial septum,oval fossa and coronary sinus (CS) were marked.Based on the principle of electrode development in CARTO 3 system,the tail end of ASP needle was connected to the main computer of CARTO3 through the tail line,so that the ASP needle end could be developed in 3-D reconstructed cardiac anatomy.3-D ASP was performed in left anterior oblique 45 degrees (LAO 45 degrees) and left anterior oblique 135 degrees (LAO 135 degrees) to evaluate the feasibility and safety of the clinical application of ASP.Results The right atrial model and important anatomical structures were clearly constructed in all 23 patients under 3-D mapping system, and on this basis,3-D atrial septal puncture was successfully performed.The reconstruction time of right atrium was (18.5±5.6) min,ASP time was (7.6±2.1) min,the labeling rate of oval fossa was 100.0%,the success rate of ASP was 100.0%,the x-ray exposure time was 0 min,and no case had the complication of pericardial tamponade.Conclusion Threedimensional atrial septal puncture is safe,intuitive and reliable,and can effectively reduce the radiation damage during the puncture.