CARTO三维标测系统两种建模方法结合在阵发性心房颤动射频消融术中的应用
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摘要
目的:探讨CARTO三维标测系统两种建模方法结合在阵发性心房颤动射频消融术中应用的安全性及有效性。方法:150例接受射频消融治疗的阵发性心房颤动患者随机分为3组,A组(n=50):常规点对点方式建模引导心房颤动的环肺静脉隔离术;B组(n=50):快速解剖建模方式构建左心房及肺静脉模型作为环肺静脉消融的路标指导消融。C组(n=50):点对点标测构建左心房模型,肺静脉定口完成后用快速解剖标测方法构建环肺静脉前庭,确认定口的准确性后再行房颤的射频消融。三组患者术中其余操作步骤及方法均相同。分别记录三组手术操作时间,X线曝光时间,成功率及并发症的发生率。超声心动图测量术前与术后6个月左心房大小及左心室收缩功能变化。结果:C组手术操作时间及X线曝光时间均明显低于A、B组(P<0.05),C组成功率略高于A组及B组,但差异无统计学意义。三组患者均无严重并发症的发生。超声心动图检测显示术后6个月左心房大小及左心室射血分数与术前相比无明显变化。结论:CARTO两种建模方法结合指导房颤的射频消融是安全、有效的,可减少手术操作时间及X线曝光时间,提高环肺静脉定口的准确性,对心房颤动的射频消融具有一定的指导意义。
Objective: To explore the safety and efficacy of two modeling methods of CARTO3 system for radiofrequency catheter ablation(RFCA) in paroxysmal atrial fibrillation(PAF) patients. Methods: A total of 150 PAF patients with RFCA were randomly divided into 3 groups: Group A: using conventional point-to-point mapping to guide circumferential pulmonary vein isolation; Group B, using fast anatomical modeling to guide circumferential pulmonary vein RFCA; Group C, using combined application of 2 mapping methods to guide circumferential pulmonary vein RFCA. n =50 in each group and the rest operative procedures were the same in 3 groups. The operative time, X-ray exposure time, success rate and complication rates were recorded in 3 groups; the size of left atrium and systolic function of left ventricle at pre-and 6 months post-operation were compared.Results: Compared with Group A and Group B, Group C had the shorter operative time and X-ray exposure time, P<0.05; the success rates were similar among 3 groups. No serious complication occurred in all 3 groups. Echocardiography presented that compared with pre-operative condition, the size of left atrium and LVEF were similar at 6 months post-operation.Conclusion: Combined using of two modeling methods of CARTO3 system was safe and effective for RFCA in PAF patients; it may reduce the operative time and X-ray exposure time, improve the accuracy of circumferential pulmonary vein locating and help guiding RFCA of PAF at certain degree.
Objective: To explore the safety and efficacy of two modeling methods of CARTO3 system for radiofrequency catheter ablation(RFCA) in paroxysmal atrial fibrillation(PAF) patients. Methods: A total of 150 PAF patients with RFCA were randomly divided into 3 groups: Group A: using conventional point-to-point mapping to guide circumferential pulmonary vein isolation; Group B, using fast anatomical modeling to guide circumferential pulmonary vein RFCA; Group C, using combined application of 2 mapping methods to guide circumferential pulmonary vein RFCA. n =50 in each group and the rest operative procedures were the same in 3 groups. The operative time, X-ray exposure time, success rate and complication rates were recorded in 3 groups; the size of left atrium and systolic function of left ventricle at pre-and 6 months post-operation were compared.Results: Compared with Group A and Group B, Group C had the shorter operative time and X-ray exposure time, P<0.05; the success rates were similar among 3 groups. No serious complication occurred in all 3 groups. Echocardiography presented that compared with pre-operative condition, the size of left atrium and LVEF were similar at 6 months post-operation.Conclusion: Combined using of two modeling methods of CARTO3 system was safe and effective for RFCA in PAF patients; it may reduce the operative time and X-ray exposure time, improve the accuracy of circumferential pulmonary vein locating and help guiding RFCA of PAF at certain degree.
引文
[1]Kirchhof P,Benussi S,Kotecha D,et al.2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.Eur Heart J,2016,37:2893-2962.
[2]Kaba RA,Cannie D,Ahmed O.RAAFT-2:Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation.Glob Cardiol Sci Pract,2014,2:53-55.
[3]Mahida S,Sacher F,Derval N,et al.Science Linking pulmonary veins and atrial fibrillation.Arrythm Electrophysiol Rev,2015,4:40-43.
[4]Stabile G,Scaglione M,del Greco M,et al.Reduced fluoroscopy exposure during ablation of atrial fibrillation using a novel electroanatomical navigation system:a multicentre experience.Europace,2012,14:60-65.
[5]January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.J Am Coll Cardiol,2014,64:e1-76.
[6]Calkins H,kuck KH,Cappato R,et al.2012 HRS/EHRA/ECASexpert consensus statement on catheter and surgical ablation of atrial fibrillation:recommendations for patient selection,procedural techniques,patient management and follow-up,definitions,endpoints,and research trial design.Europace,2012,14:528-606.
[7]林创标,蔡衡,张伟,等.三维影像融合技术指引导管消融治疗心房颤动.中国心血管病研究,2015,13:738-743.
[8]Kardos A,Foldesi C,Ladunga K,et al.Highly accurate CT image and the electroanatomical map(EAM)fusion can be obtained by the Carto3D electroanatomical mapping system using CS as the key anatomical structure for registration.Indian Pacing Electrophysiol J,2007,7:142-147.
[9]Baszko1 A,?anocha M,Ka?mucki1 P,et al.Value of rotational angiography(3D-ATG)with contrast agent administration into the right atrium during atrial fibrillation ablation procedures:a preliminary report.Kardiologia Polska,2012,70:924-930.
[10]田野,杨龙,周松,等.左心房及肺静脉旋转造影嵌入实时X线透视系统指导心房颤动的射频消融.中国循环杂志,2014,29:683-685.
[11]田野,杨龙,郑亚西,等.CARTO3三维标测系统快速解剖建模在阵发性心房颤动射频消融术中的应用.中国循环杂志,2016,31:764-767.
[12]Pinto Teixeira P,Silva Cunha P,Delgado AS,et al.Penta Ray catheter in persistent atrial fibrillation ablation.Rev Port Cardiol,2016,35:121-123.
[13]Szeplaki G,Geller L,Ozcan EE,et al.Respiratory gating algorithm helps to reconstruct more accurate electroanatomical maps during atrial fibrillation ablation performed under spontaneous respiration.JInterv Card Electrophysiol,2016,46:153-159.
[14]Jones DG,Haldar SK,Hussain W,et a1.randomized trial to ossess catheter ablation versus rate control in the management of persistenta trial fibrillation in heart failure.Am Coil Cardiol,2013,61:1894-1903.
[15]Anselmino M,Matta M,D’Ascenzo F,et a1.Catheter ablation of atrial fibrillation in patients with left ventricular systolic dysfunction:a systematic review and meta-analysis.Circ Arrhythm Electrophysiol,2014,7:1011-1018.(收稿日期:2017-02-24)
[2]Kaba RA,Cannie D,Ahmed O.RAAFT-2:Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation.Glob Cardiol Sci Pract,2014,2:53-55.
[3]Mahida S,Sacher F,Derval N,et al.Science Linking pulmonary veins and atrial fibrillation.Arrythm Electrophysiol Rev,2015,4:40-43.
[4]Stabile G,Scaglione M,del Greco M,et al.Reduced fluoroscopy exposure during ablation of atrial fibrillation using a novel electroanatomical navigation system:a multicentre experience.Europace,2012,14:60-65.
[5]January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.J Am Coll Cardiol,2014,64:e1-76.
[6]Calkins H,kuck KH,Cappato R,et al.2012 HRS/EHRA/ECASexpert consensus statement on catheter and surgical ablation of atrial fibrillation:recommendations for patient selection,procedural techniques,patient management and follow-up,definitions,endpoints,and research trial design.Europace,2012,14:528-606.
[7]林创标,蔡衡,张伟,等.三维影像融合技术指引导管消融治疗心房颤动.中国心血管病研究,2015,13:738-743.
[8]Kardos A,Foldesi C,Ladunga K,et al.Highly accurate CT image and the electroanatomical map(EAM)fusion can be obtained by the Carto3D electroanatomical mapping system using CS as the key anatomical structure for registration.Indian Pacing Electrophysiol J,2007,7:142-147.
[9]Baszko1 A,?anocha M,Ka?mucki1 P,et al.Value of rotational angiography(3D-ATG)with contrast agent administration into the right atrium during atrial fibrillation ablation procedures:a preliminary report.Kardiologia Polska,2012,70:924-930.
[10]田野,杨龙,周松,等.左心房及肺静脉旋转造影嵌入实时X线透视系统指导心房颤动的射频消融.中国循环杂志,2014,29:683-685.
[11]田野,杨龙,郑亚西,等.CARTO3三维标测系统快速解剖建模在阵发性心房颤动射频消融术中的应用.中国循环杂志,2016,31:764-767.
[12]Pinto Teixeira P,Silva Cunha P,Delgado AS,et al.Penta Ray catheter in persistent atrial fibrillation ablation.Rev Port Cardiol,2016,35:121-123.
[13]Szeplaki G,Geller L,Ozcan EE,et al.Respiratory gating algorithm helps to reconstruct more accurate electroanatomical maps during atrial fibrillation ablation performed under spontaneous respiration.JInterv Card Electrophysiol,2016,46:153-159.
[14]Jones DG,Haldar SK,Hussain W,et a1.randomized trial to ossess catheter ablation versus rate control in the management of persistenta trial fibrillation in heart failure.Am Coil Cardiol,2013,61:1894-1903.
[15]Anselmino M,Matta M,D’Ascenzo F,et a1.Catheter ablation of atrial fibrillation in patients with left ventricular systolic dysfunction:a systematic review and meta-analysis.Circ Arrhythm Electrophysiol,2014,7:1011-1018.(收稿日期:2017-02-24)