左心房及肺静脉同步食管CT血管造影检查指导心房颤动射频消融术中解剖位置

Treatment of atrial fibrillation by radiofrequency ablation under the anatomical guidance by CT angiography of left atrium and pulmonary veins combined with esophagus

目的分析左心房及肺静脉同步食管CT血管造影检查应用于指导心房颤动射频消融术中解剖位置的价值。方法选取我院2018年7月~2020年10月收治的61例心房颤动患者作为实验组,另选取31例非心房颤动的患者作为对照组,两组患者均接受左心房及肺静脉同步食管CT血管造影检查。对比两组患者各支肺静脉开口和食管径线、左心房大小和体积、食管走行分型。结果实验组肺静脉上下径右下开口显著高于对照组,肺静脉前后径右上开口显著低于对照组(P<0.05);两组患者食管跨左心房后壁距离、食管前壁到左心房的最短距离、左心房后壁厚度以及食道厚度差异均无统计学意义(P>0.05);实验组比对照组左心房前后径和左心房体积更高(P<0.05)。根据食管走行分型后发现,实验组Ⅰa型39例,Ⅰb型12例,Ⅰc型11例,Ⅱa型5例,Ⅱb型3例,Ⅱc型2例;对照组Ⅰa型13例,Ⅰb型6例,Ⅰc型6例,Ⅱa型3例,Ⅱb型2例,Ⅱc型1例。结论左心房及肺静脉同步食管CT血管造影检查应用于心房颤动射频消融术中价值较高,能够有效指导解剖位置,同时了解患者肺静脉和心房的变化情况,使手术安全性得到提高。

Objective To explore the value of the CT angiography examination in the left atrium,pulmonary vein and esophagus in guiding the anatomical position during radiofrequency ablation of atrial fibrillation.Methods Sixty-one cases of atrial fibrillation and 31 cases of non-atrial fibrillation underwent CT angiography examination of the left atrium,pulmonary veins and esophagus in our hospital from July 2018 to October 2020 were enrolled.The patients were divided into set experimental group and control group.The diameters of pulmonary vein ostia,diameter of the esophagus,left atrium anteroposterior diameter and the left atrium volume as well as the anatomical types of easophagus were compared between two groups.Results The superoinferior diameters of right inferior pulmonary vein ostia of experimental group were larger than those of control group(P<0.05).The anteroposterior diameters of right superior pulmonary vein ostia of experimental group were smaller than those of control group(P<0.05).The mean length of left atrium posterior wall segment,median least distance between esophageal anterior wall and left atrium,mean thickness of left atrium posterior wall,and mean thickness of esophagus segment showed no significant difference between groups(P>0.05).The left atrium anteroposterior diameter and the left atrium volume were larger in experimental group than in control group(P<0.05).The experimental group included 39 cases of type Ⅰa,12 cases of type Ⅰb,11 cases of type Ⅰc,5 cases of type Ⅱa,3 cases of type Ⅱb and 2 cases of type Ⅱc;while control group included 13 cases of type Ⅰa,6 cases of type Ⅰb,6 cases of type Ⅰc,3 cases of type Ⅱa,2 cases of type Ⅱb and 1 case of type Ⅱc.Conclusion Anatomical guidance by CT angiography of left atrium and pulmonary veins combined with esophagus has great value in the treatment of atrial fibrillation by radiofrequency ablation,which can effectively reveal the changes of pulmonary vein and atrium.