摘要
目的探讨Cartomerge技术联用单根Lasso导管指导心房颤动(简称房颤)射频导管消融的安全性和有效性。方法对2006年5月至2008年8月在广西医科大学第一附属医院接受治疗的40例房颤患者用Cartomerge技术指导射频导管消融治疗房颤。术中用Carto导管标测和构建左心房和肺静脉的电解剖图,然后与术前心脏CT造影的三维图像进行数据整合形成二者的复合图形(Cartomerge)。在Cartomerge的指导下对房颤患者行环绕同侧肺静脉的线性消融,射频消融终点为Lasso导管标测证实所有肺静脉均达到电隔离效果。如房颤不终止,依次进一步消融左房顶部线、二尖瓣峡部线及三尖瓣峡部线,如上述部位消融后房颤仍未终止,予静脉注射普罗帕酮70mg,不能复律时,行同步直流电复律恢复窦性心律。结果40例房颤均达到射频消融终点。手术时间是(255.0±79.45)min,曝光时间是(43.0±19.05)min。未发生心脏穿孔和肺静脉狭窄等严重并发症,其中28例患者经4～14个月随访均维持窦性心律,近期手术成功率为70%。结论联合应用Cartomerge技术和单根Lasso导管指导进行房颤射频导管消融安全有效,可简化操作,提高消融手术的成功率,并且减少X线曝光时间。
Objective To investigate the safety and effectiveness of the Carto merge technique in combination with single Lasso in guiding radiofrequency catheter ablation（RFCA） in the treatment of permanent atrial fibrillation（AF）. Methods A total Of 40 patients with AF underwent RFCA under the guidance of the Carto merge technique. The virtual electroanatomical maps of the left atrium（LA） and pulmonary veins（PVs） were reconstructed with Carto system during the procedure. Then the electroanatomical map was subsequently integrated with 3-D images of cardiac magnetic resonance angiography to form the Carto merge map. The circumferential pulmonary vein ablation was performed firstly until the complete PVs electric isolation was confirmed by lasso catheter. If AF was not terminated, lesion lines on roof Of LA, mitral isthruns, and tricuspid isthruns were in turn by catheter ablated. Cardioversion was performed by means of drugs（Propafenone） or finally by direct current（DC） cardiovemion if sinus rhythm could not returnResults AF was terminated in all patients after the treatment. The total operation time was （ 255.0 ±79. 45 ） rain and the exposure time was （43.0 ±19. 05 ） min. No serious complication or recurrence was found during the 4 - 14 months of follow-up. Conclusion Carto merge technique in combination with single Lasso was effective in guiding RFCA for the treatment of AF, by which the mapping procedure was simplified, the probability of success enhanced and the costs as well as X · ray exposure reduced comparing to the conventional approaches.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2010年第3期238-240,I0001,共4页
Chinese Journal of Practical Internal Medicine
基金
广西科学研究与技术开发计划项目(桂科攻0592007-1D)
