Initial experience with circumferential pulmonary vein ablation guided by fusion of magnetic resonance imaging with three-dimensional electroanatomic mapping

Catheter ablation for the treatment of atrial fibrillation （AF） has been a focal target ofelectrophysiological study in recent years. Up to date, circumferential pulmonary vein ablation （CPVA） guided by three-dimensional （3-D） electreanatomic mapping （Carto, USA） has been one of the most favourable procedures for the treatment of AF. However, it is still difficult to acquire the detailed information on number, location, and branching pattern of all pulmonary veins （PVs） when the 3-D electroanatomic mapping system is used alone.

应用重叠参考图像技术及CartoMerge技术指导环肺静脉电隔离术治疗阵发性心房颤动的临床体会

目的报道应用重叠参考图像技术指导的CartoMerge进行环肺静脉电隔离术的结果。方法在重叠参考图像技术(将参考图像以反白的形式叠加于透视屏上)的指导下,可准确定位各支肺静脉的顶部及底部,从中选取解剖点作为CartoMerge的陆标。CartoMerge完成后,重叠参考图像技术又可用于指导消融导管的定位。结果本研究入选129例阵发性心房颤动患者均在重叠参考图像技术的指导下成功完成CartoMerge及导管消融。前40例行标准CartoMerge,三维电解剖标测与CT图像的平均空间差异为(1.42±0.67)mm,肺静脉隔离率为96%,消融操作时间为(92±17)min,整个手术总耗时(139±32)min。后89例行简化的CartoMerge,即不用Carto构建完整的左心房模型,而仅选择3～4对陆标进行图像融合操作,手术总耗时进一步缩短至(115±38)min。结论重叠参考图像技术有助于指导阵发性心房颤动的导管消融,并可有助于规范陆标的选择。

CartoXP Guided Catheter Ablation for Paroxysmal Atrial Fibrillation Without Three-dimensional Modeling of Left Atrium and Pulmonary Veins

Objectives This study was to investigate the differences between modeling and non-modeling left atrium （LA） in CartoXP system guided catheter ablation for paroxysmal atrial fibrillation （PAF）. Methods From Jan to Dec in 2008 total 31 cases with PAF were enrolled. All were treated by the same electrophysiologist with CartoXP guidance. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients （non-modeling group） and with left atrium modeling in 14 patients （modeling group）. The detailed ablation method was based on circumferential pulmonary veins isolation （CPVI）. And linear ablation of tricuspid valvular isthmus was performed individually. The ablation endpoint was a complete isolation of pulmonary vein potential from left atrium and no further induced continuous fast atrial arrhythmia including atrial fibrillation （AF）, atrial flutter （AFL） and atrial tachycardia （AT）. Each step for the procedures and the follow-up outcomes were compared correspondingly. Results The total procedure time was 107.23 ± 28.92 min in modeling group vs 93.47 ±26.09 min in non-modeling group （ P 〉 0.05 ）. The X-ray exposure time was significantly longer in modeling group （21.09 ±6. 49 rain） than in non-modeling group （14. 16 ± 5.35 min）. The CPVI times of right pulmonary veins and left pulmonary veins were 28. 14 ± 9. 26 min was 27.29 ± 18.53 min in modeling group respectively, vs 18.00 ±4. 51 min and 23.94 ± 7. 10 min in non-modeling group respectively, （P 〈 0. 05 ）. There is no significant difference between modeling group （85.7%） and non-modeling group （82.4%） over follow-up period of 2 to 13 months. Confusions CartoXP system guided catheter ablation of PAF without modeling of left atrium and pulmonary veins took less time in X-ray exposure and ablation steps, comparing with left atrium modeling procedure.

应用重叠参考图像透视技术易化环肺静脉电隔离术操作治疗阵发性心房颤动

目的探讨重叠参考图像透视技术（OverlayRef）对环肺静脉电隔离术治疗阵发性心房颤动（房颤）的影响。方法人选194例阵发性房颤患者，随机分为OvedayRef组（97例）及对照组（97例）。OverlayRef组使用OverlayRef技术（将参考图像以反白的形式叠加于透视屏上）辅助环肺静脉电隔离术的操作。对照组常规方法完成环肺静脉电隔离术。比较两组的总消融手术时间、消融时间、X线曝光量、肺静脉隔离率及随访1年的成功率。结果两组患者的基线临床特征差异无统计学意义。所有患者均接受了环肺静脉电隔离术。OverlayRef组的消融时间[（89±13）min对（102±22）min，P〈0．01]和总消融术时间[（139±22）min对（162±31）min，P〈0．01]均明显比对照组短。OverlayRef组的x线曝光量[（13531±283）mGy对（13123±369）mGy]稍大，但差异无统计学意义（P〉0．05）。两组的环肺静脉电隔离率（97．9％对96．9％，P=NS）及随访1年的成功率（84．5％对81．4％，P〉0．05）差异也无统计学意义。结论OverlayRef技术可以易化环肺静脉电隔离术的操作，缩短房颤导管消融术的学习曲线。

Initial experience with circumferential pulmonary vein isolation guided~ by Overlay Ref and CartoMerge in the treatment of paroxysmal atrial fibrillation

Background CartoMerge has been widely used in guiding circumferential pulmonary vein isolation （CPVI） for the treatment of paroxysmal atrial fibrillation （PAF）. However, the procedure of landmarks selection varies among operators according to their experience. Techniques have to be established to standardize this procedure. We propose that Overlay Ref could facilitate this procedure. This paper aimed to report our initial experience with CPVI guided by Overlay Ref and CartoMerge for the treatment of PAF. Methods Fifty-nine patients with PAF were enrolled in this study. Using Overlay Ref technique, a reference image （inverted） was faded into the live fluoroscopic image. Landmarks of CartoMerge were selected from anatomic points of the top of superior pulmonary veins （PVs） and the bottom of inferior PVs guided by Overlay Ref image. Overlay Ref images were also used to guide the ablation procedure combining with CartoMerge. Results All patients were successfully mapped by CartoMerge guided by Overlay Ref. The distance between the mapping points and the CT surfaces was （1.42±0.67） mm for the patients as a whole. This led to a successful rate of 96% for isolation of pulmonary veins. Duration of ablation procedure was （92±17） minutes. And the total duration of procedure was （139±32） minutes. CartoMerge could also be performed just with 3 paries to 4 paries selected landmarks guided by Overlay Ref without a full anatomic model constructed by Carto. Then, the total duration of procedure could be shortened to （115±38） minutes. Conclusions Overlay Ref technique can facilitate the catheter ablation of PAF and can help to standardize the procedure of landmarks selection.

三维电解剖标测指导下永久His束起搏并双腔起搏器植入1例

1病例资料、患者,女,59岁,因“间断心慌、乏力5年,加重伴黑朦3个月”为主诉于2017-07-18日入院。否认其他病史,个人史、家族史无特殊。入院后体检:一般状态可,血压120/76mmHg(1mmHg=0.133kPa);心率43次/min。双肺听诊无异常,心律不齐,可闻及期前收缩,各瓣膜听诊区未闻及杂音,下肢轻度水肿。