超声消融肺静脉口对血流动力学影响的实验研究

The influence of ultrasound ablation of the orifice of pulmonary veins on hemodynamics

目的 通过观察超声消融肺静脉口对血流动力学的影响 ,对超声消融的安全性进行探讨 ,为临床应用提供依据。方法 健康成年杂种犬 6只 ,经房间隔途径将超声消融电极置入肺静脉内进行消融 ,预设温度 5 5～ 6 5℃ ,消融时间 6 0s ,消融前、消融后即刻监测心电图 ,行选择性肺静脉造影 ,并测量右房压 (RAP)、右室压 (RVP)、主肺动脉压 (PAP)及左房压 (LAP)。术后留养 3个月 ,重复以上检查。结果 除一只犬因房间隔穿刺致心包填塞于术后 8h死亡 ,其余均顺利完成试验。共消融肺静脉 19支 ,平均每只犬 3 2支。消融术中均达到有效消融温度 (5 5℃以上 ,持续 30s以上 ) ,术后即刻及 3个月行电生理检查示消融处均达到有效电隔离。对术后即刻、术后 3个月的血流动力学进行观察 ,亦未发现显著变化。结论 超声消融肺静脉口容易达到消融终点 ,且未对血流动力学产生不良影响 ,是一种临床上治疗起源于肺静脉内局灶性心房颤动的安全、有效方法。

Objective To observe the influence of catheter ablation of the orifice of pulmonary veins (PVs) using ultrasound energy on hemodynamic parameters and explore the safety and efficacy of ultrasound ablation. Methods Nineteen PVs of six canines received ultrasound ablation, with a preset ablation temperature between 55 ℃-65 ℃, for 60 seconds. Ultrasound ablation catheter was positioned on the orifice of PVs via transseptal approach under fluoroscopic. Selective pulmonary venography was undertaken and the hemodynamic data were measured before ablation? immediately and three months later after the ablation.Results All except one canine completed the experiment. All the PVs got effective electrical isolation, and had no stenosis with pulmonary venography, no significant change in hemodynamic parameters was observed before, immediately or three months later after the ablation. Conclusion Catheter ablation within PVs by ultrasound energy was safe and efficient, it was a useful method to treat focal atrial fibrillation derived from PVs in clinical practice.