论文部分内容阅读
目的评价三维电解剖(Carto)标测系统合并图像融合(Merge)技术指导下行环肺静脉线性消融术治疗心房颤动(房颤)的临床疗效,并与单纯用Carto系统治疗组比较。方法回顾性分析2005年3月至2007年1月间接受导管射频消融术的连续68例房颤患者,其中单纯Carto标测系统指导下手术患者11例(A组),Carto-Merge技术指导下手术患者57例。消融策略:先行左房肺静脉电隔离,必要时加行左房碎裂电位消融+左房顶部、底部、峡部+右房三尖瓣峡部、上腔静脉、冠状静脉窦口部消融。结果A组平均X线透视时间56.24±13.92min,平均随访15.08±1.82个月,7例(57.14%)术后3个月生活质量明显改善,无房颤发作;其中阵发性房颤手术成功率为60%,2例接受第二次消融后治愈。B组平均X线透视时间33.32±13.84min,平均随访8.97±6.28个月,51例(89.47%)术后3个月生活质量明显改善,无房颤发作;其中阵发性房颤手术成功率达95.12%;其X线透视时间,总体及阵发性房颤手术成功率均与A组有明显差异;B组中3例扩张型心肌病和1例肥厚型心肌病房颤消融成功,术后心功能明显改善。结论在Carto-Merge技术指导下行环肺静脉线性消融术治疗房颤能提高手术效率及成功率,进一步减少X线曝光时间。左房肺静脉电隔离+左房碎裂电位消融+左房顶部、底部、峡部+右房三尖瓣峡部、上腔静脉、冠状窦口的消融可能通过改良心房基质而提高房颤手术成功率。
Objective To evaluate the clinical efficacy of three-dimensional electrocardiographic (Carto) mapping combined with image fusion (Merge) technique to guide the descending circumferential pulmonary vein ablation for the treatment of atrial fibrillation (AF) and compare it with that of the Carto system alone. Methods A total of 68 patients with atrial fibrillation undergoing radiofrequency catheter ablation from March 2005 to January 2007 were retrospectively analyzed. Among them, 11 patients (A group) under the guidance of Carto mapping system were under the guidance of Carto-Merge technique 57 cases of surgical patients. Ablation strategy: first left atrial pulmonary venous isolation, if necessary, plus left atrial fissuration potential ablation + left atrium top, bottom, isthmus + right atrial tricuspid isthmus, superior vena cava, coronary sinus ostium ablation. Results In group A, the average X-ray fluoroscopy time was 56.24 ± 13.92min with an average follow-up of 15.08 ± 1.82 months. The quality of life in 7 cases (57.14%) was significantly improved at 3 months after operation without any atrial fibrillation. The successful operation of paroxysmal atrial fibrillation Rate of 60%, 2 cases were cured after the second ablation. In group B, the average X-ray fluoroscopy time was 33.32 ± 13.84min with an average follow-up of 8.97 ± 6.28 months, and 51 cases (89.47%) had a significant improvement in quality of life at 3 months after operation without atrial fibrillation. The success rate of paroxysmal atrial fibrillation Up to 95.12%. The X-ray fluoroscopy time, overall and the success rate of paroxysmal atrial fibrillation were significantly different from that of group A. Three cases of dilated cardiomyopathy and one case of hypertrophic cardiomyopathy were successfully ablated in group B After heart function improved significantly. Conclusions The technique of Carto-Merge guided by circumferential pulmonary vein ablation for atrial fibrillation can improve the operation efficiency and success rate, and further reduce the X-ray exposure time. Left atrial pulmonary venous electrical isolation + left atrial fissure potential ablation + left atrial top, bottom, isthmus + right atrial tricuspid isthmus, superior vena cava, coronary sinus ablation may improve the atrial fibrillation and improve the success rate of surgery.