三维心脏电解剖标测结合CT影像融合指导心房颤动射频消融治疗

近年来，随着医疗器械和技术的进步，经导管射频消融已成为心房颤动现代治疗的主要方法之一，国内许多医疗中心相继开展了心房颤动的三维心脏电解剖标测消融治疗，该方法可以将电学标测与解剖标测结合起来，大大提高了心律失常，尤其是复杂心律失常的消融效果和安全性。该方法的不足之处在于解剖标测必需参照X线影像的指导，标测方法粗糙、费时。     

三维电解剖标测系统结合肺静脉前庭电位指导心房颤动经导管消融

背景:目前常用的肺静脉前庭定位手段主要是通过三维电解剖标测(CARTO)结合X射线影像或CT影像融合等完成,这些方法均是通过解剖指导进行肿静脉前庭定位、消融,消融是否命中心房颤动(房颤)赖以维持的关键部位不得而知.目的:验证三维电解剖标测系统结合肺静脉前庭电位指导房颤经导管消融治疗的可行性.设计、时间及地点:验证性临床试验,于2007-03/2009-06在济南市第四医院及河北省人民医院心内科完成.对象:纳入药物治疗无效的症状性阵发性房颤患者51例.方法:于CARTO标测系统结合肺静脉前庭电位标测指导下行环肺静脉前庭线性消融,消融终点为肺静脉隔离,观察操作相关参数及消融成功率.主要观察指标:观察手术操作时间、X射线照射时间、手术成功率及并发症等操作相关参数.结果:51例患者均实现消融终点.平均操作时间(207±36.7)min,透视时间(38.2±14.3)min,消融时间(56.4±15.7)min.经过(17.5±3.8)个月的随访,累计40例(78.4%)无房颤、心房扑动及房性心动过速等心律失常发生.无严重操作相关并发症发生.结论:肺静脉前庭电位标测有助于肺静脉前庭的解剖定位,结合三维电解剖系统指导房颤消融效果好,安全性高,方法可行.     

三维心脏电解剖标测结合CT影像融合技术指导复杂房性心律失常的射频消融治疗

对于复杂的房性心律失常,常规电生理标测困难,消融成功率较低,X线曝光时间延长。在三维心脏电解剖标测结合CT影像融合技术（Carto-Merg）指导下提高了标测的准确性和消融的成功率。本研究报道42例复杂房性心律失常应用Carto—Merg指导下行射频消融手术,旨在探讨Carto—Merg指导复杂房性心律失常射频消融治疗的作用和优势。     

三维电解剖标测系统联合单根环状导管指导阵发性心房颤动射频消融临床观察

心房颤动（atrial fibrillation,AF）是临床上常见的心律失常,人群中发病率高达0.9%-2.5%,且随年龄的增加发病率上升,是脑卒中和心力衰竭的最强烈的独立危险因素。药物治疗的总体效果差。     

三维电解剖标测系统指引下射频消融治疗心房颤动的护理

总结30例三维电解剖标测系统指引下射频消融治疗心房颤动的护理。认为治疗前做好各项准备,治疗中加强病情观察,监测射频仪各参数,治疗后做好一般护理,给予饮食指导,加强并发症的观察与护理,可提高心房颤动射频消融治疗的成功率。     

应用三维电解剖标测系统与常规方法指导射频消融治疗心房扑动的对比研究

目的快速三维心内膜电解剖标测（Carto）系统可较好的显示心脏解剖的三维结构。本研究通过Carto系统与常规方法指导下标测和射频消融心房扑动（房扑）的比较,评价Carto系统的临床应用价值。方法30例房扑患者,常规组16例,行常规方法和X线透视下标测和消融;Carto组14例,在房扑持续发作时,应用Carto系统在相关心房标测,实时重建心腔三维电解剖图,设计消融路标放电消融,然后验证消融效果。比较两组的手术即时成功率、手术时间、曝光时间及并发症和随访结果。结果常规组16例中,14例典型房扑,2例非典型房扑;15例即时消融成功。Carto组14例中,11例典型房扑,3例非典型房扑,均即时消融成功。两组间比较,Carto组较常规组曝光时间显著缩短,（36．1±8．7）min vs（48．5±19．1）min（P〈0．01）。手术时间延长,（224．6±45．3）minVS（181．4±61．6）min（P〈0．05）。两组均无严重并发症。随访4～8个月,常规组中1例2周后复发,第2次消融采用常规方法消融成功。结论本研究显示,应用Carto系统标测和消融房扑安全有效,较常规方法定位准确可靠、明显缩短曝光时间,且有定位记忆功能,尤其是在复杂的房扑,有助于准确定位靶点和判断线性损伤的连续性。     

三维电解剖标测系统指导下射频消融房性心动过速的临床研究

目的：探讨三维电解剖标测系统（CARTO）指导下进行房性心动过速射频消融的方法及效果。方法：对40例房性心动过速患者应用CARTO标测心房,构建三维电解剖图,分析房性心动过速的电生理机制。局灶性房速消融最早激动点,大折返性房速消融折返环的关键性峡部。选择利用常规方法行消融的28例患者作为对照组。比较两组消融的成功率、X线曝光时间。结果：38例患者CARTO三维标测系统标测提示为局灶性房性心动过速,最早激动点位于右心房35例,其中冠状静脉窦口8例（20%）、间隔部10例（25%）、侧壁8例（20%）、上腔静脉口附近4例（10%）、后壁4例（10%）,1例患者（2.5%）有3种类型房速（分别为间隔部、上腔静脉口的局灶房速和三尖瓣峡部依赖的大折返房速）。位于左心房的局灶房速3例,分别位于右上肺静脉口（2.5%）、左上肺静脉口（2.5%）及左心耳（2.5%）。2例患者为大折返房速（5%）,1例为三尖瓣峡部依赖性,1例为围绕界嵴的大折返房速。均消融成功（100%）,随访4～16个月,均无复发。常规消融组成功率为89.3%（P〈0.05）。CARTO组X线曝光时间比常规组明显缩短,分别为（13.8±5.5）min和（30.4±12.9）min,差异有统计学意义（P〈0.05）。结论：应用CARTO标测房性心动过速,对分析房性心动过速的机制准确快速,能有效指导射频消融。     

Carto标测系统指导下射频消融治疗心房颤动的护理

目的:探讨房颤患者在Carto标测系统指导下射频消融治疗心房颤动的护理体会。方法:对35例患者在Carto标测系统指导下行射频消融术。结果:32例患者手术一次成功3,例患者一次射频消融未成功,3个月后再次行射频消融术后成功。结论:通过加强术前术后护理,有效减少及预防了疾病并发症,促进了患者的康复。     

心房颤动导管消融治疗进展

导管消融转复并维持窦性心律可以改善心房颤动（简称房颤）患者的心功能和提高生活质量，本文主要介绍房颤发病与维持的机制，导管消融适应证、术式及其联合使用、术后复发、并发症、标测与影像学技术、消融能源以及发展趋势。     

三维电解剖标测系统指导射频消融术治疗心房颤动的护理

目的 探讨三维电解剖标测系统指导射频消融术治疗心房颤动的临床治疗效果观察及其护理.方法 对37例接受三维标测系统指导射频消融术治疗心房颤动患者的护理措施进行分析.结果 37例患者射频消融治疗后,27例根治,10例有效.结论 充分良好的术前准备、术中配合、术后监护及康复指导,是手术治疗成功的重要保障.     

三维电解剖标测系统指导射频消融术治疗心房颤动的护理

目的 探讨三维电解剖标测系统指导射频消融术治疗心房颤动的临床治疗效果观察及其护理.方法 对37例接受三维标测系统指导射频消融术治疗心房颤动患者的护理措施进行分析.结果 37例患者射频消融治疗后,27例根治,10例有效.结论 充分良好的术前准备、术中配合、术后监护及康复指导,是手术治疗成功的重要保障.     

CARTO系统指导下行心房颤动导管消融术病人的护理

[目的]探讨CARTO系统指导下行心房颤动经导管射频消融治疗术病人的护理。[方法]对52例心房颤动病人行射频消融治疗,经穿刺房间隔,常规置管,在CARTO指导下构建左房电解剖图,所有病人均完成环肺静脉消融,部分病人加行左房顶部线,二尖瓣峡部线和(或)三尖瓣峡部线消融,同时加强护理。[结果]52例心房颤动病人成功接受经导管射频消融治疗术;术后并发心包渗出1例,迷走神经反射5例,局部出血与血肿2例;18例病人术后因心房颤动发作出现明显的紧张、焦虑、抑郁、失望等心理问题。[结论]加强CARTO系统指导下行心房颤动经导管射频消融治疗术的护理是手术成功的保证。     

Characteristics in image integration system guiding catheter ablation of atrial fibrillation with a common ostium of inferior pulmonary veins

BACKGROUND: Common ostium of the inferior pulmonary veins (PVs) is a kind of unusual variation in pulmonary venous drainage to the left atrium (LA), whose feature of anatomy, electrophysiology, and catheter ablation is rarely demonstrated, and the consecutive series of research for catheter ablation of atrial fibrillation (AF) in patients with that anomaly have not been reported. METHODS: A total of 1,226 patients with drug-refractory AF received magnetic resonance angiography (MRA) or multidetector computed tomography (MDCT) scan before ablation. Electrophysiological mapping was used to detect the focal triggers in paroxysmal AF. Basic catheter ablation strategy was circumferential PV isolation with "tricircle" under the guidance of image integration system: two circles surround two superior PVs, and the other surround the common trunk. RESULTS: LA and PVs reconstruction by image integration system showed a common pulmonary venous ostium of the right and left inferior PVs before ablation in 11 patients (0.9%). This anomaly could be classified into two types: type A without a short common trunk of inferior PVs and type B with a short common trunk. Fifty-seven percent paroxysmal AF was revealed focal triggers in the common ostium. The success rate of that strategy was 90%. CONCLUSION: Common ostium of inferior PVs could be classified into two types according to the presence of a short common trunk or not. The common ostium was usually an important triggering focus in paroxysmal AF. Catheter ablation strategy of circumferential PV isolation with "tricircle" under the guidance of image integration system would be a good choice.     

Impact of respiration gating on image integration guided atrial fibrillation ablation

Background

Radiofrequency (RF) catheter ablation guided by electroanatomic mapping systems is an effective therapy for atrial fibrillation. However, it may be affected by respiration movements. The aim of this study was to determine the impact of respiratory gating on procedural parameters in patients undergoing catheter ablation of atrial fibrillation (AF).

Methods and results

One-hundred forty consecutive patients undergoing pulmonary vein isolation were admitted to study. Respiratory gating module (AccuResp algorithm, Carto3, Biosense Webster) was enabled in 70 patients and disabled in 70 patients during procedures. Successful pulmonary vein isolation and sinus rhythm were obtained in all patients. A significant reduction in total procedure times [median 77, interquartile range (IQR 66–95) min vs median 82 (IQR 72–104) min, p < 0.05] and fluoroscopy times [median 14 (IQR 9–17) min vs median 16 (IQR 12–22) min, p < 0.05] were observed in the respiratory gated group. Although ablation times (duration between the first and last ablation) were significantly shorter in respiratory gated group [median 37 (IQR 32–53) min vs median 48 (IQR 39–65) min, p < 0.05], total RF application durations were not different between two groups [median 1,554 (IQR 1,213–2,196) s vs median 1,802 (IQR 1,344–2,448) s, p = 0.11]. Difference in electroanatomical map reconstruction times was not significant [median 14 (IQR 12–16) min in gated group vs median 13 (IQR 10–18) min in nongated group, p = 0.19].

Conclusion

Respiratory gating significantly improves fluoroscopy and ablation times during electroanatomic mapping guided AF ablation. Respiratory gated maps may provide uninterrupted continuous ablation applications. Furthermore, using automatic respiratory gating module does not prolong mapping times.     

Percutaneous catheter ablation of atrial fibrillation

Atrial fibrillation is the most common arrhythmia and is associated with important morbidity and mortality. Antiarrhythmic therapy is recommended as initial therapy but is associated with modest efficacy and significant side effects. Over the past several years, catheter ablation has been demonstrated to provide effective and safe curative therapy for atrial fibrillation. Future investigations will assess advances in catheter ablation technology and will help to define the precise role of catheter ablation relative to alternative therapies, such as rate-control and antiarrhythmic therapy.     

Percutaneous catheter ablation of atrial fibrillation

Atrial fibrillation is the most common arrhythmia and is associated with important morbidity and mortality. Antiarrhythmic therapy is recommended as initial therapy but is associated with modest efficacy and significant side effects. Over the past several years, catheter ablation has been demonstrated to provide effective and safe curative therapy for atrial fibrillation. Future investigations will assess advances in catheter ablation technology and will help to define the precise role of catheter ablation relative to alternative therapies, such as rate-control and antiarrhythmic therapy.     

Paroxysmal atrial fibrillation ablation with the multipolar mapping and ablation catheter (Mesh-Bard)

Pulmonary veins (PVs) ablation is a valid treatment option for atrial fibrillation. The standard approach for PVs isolation usually requires two catheters or an electroanatomical reconstruction of the left atrium. We describe our initial experience with a single device for mapping and ablating in a patient referred to our center for the relapsing of atrial fibrillation 3 years after a previous ablation procedure. The newly available catheter MESH was safe and effective to quickly isolate two reconnected PVs.