三维影像融合技术指引导管消融治疗心房颤动

目的 探索三维影像融合技术指引导管消融治疗心房颤动的意义。方法 入选66例房颤患者，随机分为两组，Carto组(32例)和Carto-Merge组(34例)，分别在单独Carto三维标测和Carto-Merge融合CT影像指导下行环肺静脉前庭线性消融，持续性房颤和持久性房颤附加行左房顶部、二尖瓣峡部线和右房三尖瓣峡部线消融，消融终点为环肺静脉彻底隔离，消融线双向阻滞，术后随访18个月。对比两组手术操作时间、射频消融时间、X线曝光时间、手术并发症及随访成功率和房性心律失常复发构成比的差异。结果 ①两组患者基线资料无明显差异(P>0.05)；②Carto-Merge组肺静脉即时隔离率高于Carto组，平均手术操作、射频消融、X线曝光时间及并发症发生率均低于Carto组(P<0.05)；③随访完成后，两组射频消融成功率、复发房性心律失常构成类型比较无明显差异(P>0.05)。结论 三维电解剖标测合并CT影像融合在保证房颤射频消融成功率的前提下，提高了手术效率，降低手术并发症，减少X线曝光，尤其对初期开展房颤消融工作度过学习曲线大有帮助，值得临床射频电生理手术尝试应用。

Three-Dimensional image integration on guidance for catheter ablation of atrial fibrillation

Objective To investigate the influence about Three-dimensional electronatomical mapping with CT image integration on guidance for catheter ablation of atrial fibrillation. Methods Sixty-six atrial fibrillation patiens were randomly divided into two group: Carto group(n=32): underwent circumferential pulmonary vein antrum ablation guided by 3D mapping alone; Carto-Merge group(n=34): underwent circumferential pulmonary vein antrum ablation guided by 3D mapping integratded with CT image; Persistent or Permanent atrial fibrillation patients were performed additional for atrial roof, mitral isthmus line and cavotricuspid isthmus. Endpoint were circumferential pulmonary vein isolation, linear ablation bi-directional electrical isolation, then follow up eighteen months after the procedure. Compared the procedure /radiofrequency ablation/fluoroscopy duration, complication, cumulative success rate, and recurrent atrial tachyarrhythmia proportional rate between the two groups. Results First, the baseline clinical material between the two groups were no significant different(P>0.05); Second, Carto-Merge group when compared to Carto group, the real-time isolation rate were higher, procedure/radiofrequency ablation/fluoroscopy duration, complication rate were lower(P<0.05); Third, after twelve months follow up, the cumulative success rate and recurrent atrial tachyarrhythmia proportional rate between the two groups were no significant different(P>0.05). Conclusions Three image integration on guidance for catheter ablation of atrial fibrillation, ensured success rate, highten efficiency, lower fluoroscopy duration and complication rate, were useful to shorten learning curve for initial stage doctors, it deserved to popularize.