目的探讨三维电解剖标测(CARTO)系统重建图像和预先取得的磁共振影像融合后指导心房颤动(房颤)导管消融的有效性。方法从2005年9月至2006年9月对连续100例药物治疗无效的房颤患者行导管消融治疗,基本策略均为在 CARTO 系统指导下进行环肺静脉线性消融并实现电学隔离。随机分为2组,每组50例。第1组为术前配准组,在消融开始前即进行影像配准并融合,并在此融合影像指导下进行导管消融,消融结束后进行再次融合;第2组为术后配准组,在单纯CARTO 技术指导下消融,消融结束后才进行影像配准并融合。最后比较两组的消融结果并评估消融过程中的差异。结果环肺静脉消融结束后,第1组左心房三维磁共振表面重建影像至电解剖标测图像各点平均距离为(1.6±0.7)mm,消融线上平均标记位点(75±27)个,平均 X 线透视时间(31±21)min;第2组的上述指标分别为(2.1±1.3)mm、(98±38)个、(55±29)min。以上组间比较差异都有统计学意义。将实际消融线与预定消融线比较,第2组中有组间差异的偏差区域分别是左侧肺静脉前庭顶部(15例)、底部(11例)、前下缘(23例)、前上缘(24例)和右侧肺静脉前庭后上缘(12例)、底部(10例)、前下缘(15例)。结论影像融合技术指导导管消融可提高准确性,并可减少 X 线透视时间及消融点数。
Cardiac ablation is an important modality of invasive therapy in modem cardiology, especially in the treatment of arrhythmias, as well as other diseases such as hypertrophic obstructive cardiomyopathy （HOCM）. Since Huang et alI used radiofrequency （RF） to ablate canine atrial ventricular junction, RF has developed into the leading energy source in catheter ablation of arrhythmias. However, there are several limitations associated with RF ablation, one of which is that it requires good contact and the depth of the lesion formed is usually limited. Thus, it is often very difficult to ablate arrhythmias originated at the epicardium with a routine endocardial RF delivery.
