三维心腔内超声结合全三维指引下零射线穿刺房间隔的安全性及可行性研究

Zero fluoroscopic transseptal puncture under the guidance of total 3-dimension combined with intracardiac echocardiography: a study of safety and feasibility

目的:评估三维心腔内超声(ICE)结合全三维(T3D)指引下零射线穿刺房间隔的安全性及可行性。方法:应用标测导管及消融导管构建右房、上下腔静脉及冠状窦模型,应用ICE构建左房结构。右前斜45°(RAO45°)结合左前斜135°(LAO135°)选取冠状窦口与右肺静脉开口或者右房后缘之间中点为房间隔穿刺点,在ICE结合T3D指导下进行房间隔穿刺。观察此方法房间隔穿刺成功率及并发症情况。结果:45例患者应用此方法进行房间隔穿刺,其中43例患者第1针穿刺成功(95.6%),2例患者穿刺第2针成功。平均房间隔穿刺时间(4.16±2.41)min。所有患者均无房间隔穿刺相关并发症出现。结论:应用ICE结合T3D的方法零射线穿刺房间隔安全有效,并可获得较为理想的房间隔穿刺部位。

Objective: To evaluate the safety and feasibility of zero fluoroscopic transseptal puncture(TSP) under the guidance of total 3-dimension(T3D) combined with intracardiac echocardiography. Methods: The mapping catheter or the ablation catheter was employed to perform anatomical reconstruction of the right atrium, coronary sinus, and superior and inferior vena cava, while the structure of the left atrium was created by the intracardiac echocardiography(ICE). Under the position of RAO 45° and LAO 135°, the site of transseptal puncture was defined as the midpoint of the line between the coronary sinus ostium(CSo) and the ostium of the right pulmonary vein, or the line between the CSo and the posterior border of the right atrium. TSP was performed under the dual guidance of ICE and T3D, and the success rate and complications of this method were evaluated. Results: Forty-five patients underwent TSP using this method, of whom 43 patients(95.6%) succeeded with the first attempt, and 2 patients succeeded at the repeated attempt, with a mean TSP duration of 4.16±2.41 minutes. No TSP-related complications happened in these patients. Conclusion: Zero fluoroscopic TSP under the guidance of ICE and T3D is a safe and effective method, which can facilitate the selection of the ideal TSP site.