三维电解剖标测系统结合肺静脉前庭电位指导心房颤动经导管消融
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doi:10.3969/j.issn.1673-8225.2009.52.023
李晓梅，胡福莉，齐晓勇，刘美霞，刘兵. 三维电解剖标测系统结合肺静脉前庭电位指导心房颤动经导管消融[J].中国组织
工程研究与临床康复，2009，13(52):10313-10317
[http://www.crter.org http://cn.zglckf.com]
李晓梅1，胡福莉2，齐晓勇2，刘美霞2，刘 兵1
ຫໍສະໝຸດ Baidu
Catheter ablation guided by three-dimensional electroanatomic mapping system in combination with pulmonary vein antrum potential in patients with atrial fibrillation
1 对象和方法
设计：验证性临床试验。 时间及地点：于2007-03/2009-06在济南市第四医 院及河北省人民医院心内科完成。 对象：纳入2007-03/2008-06行导管消融治疗的阵 发性房颤患者51例，在三维电解剖标测系统(CARTO标 测系统，Biosense-Webster Inc.)指导下结合肺静脉前 庭电位指导行环肺静脉前庭消融。其中男34例，女17 例；年龄36~72岁，平均(55.5±12.8)岁。房颤病史0.5~20 年，均有明显症状，且服用2种以上抗心律失常药物治 疗无效。其中12例合并器质性心脏病，包括冠状动脉粥 样硬化性心脏病5例，高血压心室肥厚6例，风湿性心脏 病二尖瓣置换后1例，左心房内径25~54 mm，平均 (41.2±5.6) mm。 所有患者均符合如下纳入标准：①多种抗心律失常 药物治疗无效的阵发性房颤，均有明显的临床症状，除 外甲状腺功能亢进症及其他急性原因引起的房颤。②左 心房前后径≤55 mm。③消融前一两日经食管超声心动 图检查未发现左心房血栓。④既往未曾接受过导管消融 治疗。⑤患者均签写手术知情同意书。 方法：
Received:2009-10-18 Accepted:2009-11-13
1 济南市第四人民 医院心内科，山东 省济南市 250031；2 河北省 人民医院心内科， 河北省石家庄市 050051
李晓梅★，女， 1968 年生，广东 省河源市人，满 族，2003 年河北 医科大学毕业，硕 士，副主任医师， 主要从事起搏和 心脏电生理研究。 lzb1967@126. com
Linchuang Kangfu 2009;13(52):10313-10317.
[http://www.crter.cn http://en.zglckf.com]
摘要 背景：目前常用的肺静脉前庭定位手段主要是通过三维电解剖标测(CARTO)结合 X 射线影像或 CT 影像融合等完成，这些 方法均是通过解剖指导进行肺静脉前庭定位、消融，消融是否命中心房颤动(房颤)赖以维持的关键部位不得而知。 目的：验证三维电解剖标测系统结合肺静脉前庭电位指导房颤经导管消融治疗的可行性。 设计、时间及地点：验证性临床试验，于 2007-03/2009-06 在济南市第四医院及河北省人民医院心内科完成。 对象：纳入药物治疗无效的症状性阵发性房颤患者 51 例。 方法：于 CARTO 标测系统结合肺静脉前庭电位标测指导下行环肺静脉前庭线性消融，消融终点为肺静脉隔离，观察操作 相关参数及消融成功率。 主要观察指标：观察手术操作时间、X 射线照射时间、手术成功率及并发症等操作相关参数。 结果：51 例患者均实现消融终点。平均操作时间(207±36.7) min，透视时间(38.2±14.3) min，消融时间(56.4±15.7) min。 经过(17.5±3.8)个月的随访，累计 40 例(78.4%)无房颤、心房扑动及房性心动过速等心律失常发生。无严重操作相关并发症 发生。 结论：肺静脉前庭电位标测有助于肺静脉前庭的解剖定位，结合三维电解剖系统指导房颤消融效果好，安全性高，方法可 行。 关键词：心房颤动；导管消融；电解剖标测；肺静脉前庭；心内电图；数字化医学
中国组织工程研究与临床康复 第 13 卷 第 52 期 2009–12–24 出版 Journal of Clinical Rehabilitative Tissue Engineering Research December 24, 2009 Vol.13, No.52
临床医学
三维电解剖标测系统结合肺静脉前庭电位指导心房颤动经导管消融★
Li XM, Hu FL, Qi XY, Liu MX, Liu B. Catheter ablation guided by three-dimensional electroanatomic mapping system in
combination with pulmonary vein antrum potential in patients with atrial fibrillation. Zhongguo Zuzhi Gongcheng Yanjiu yu
环肺静脉前庭消融是目前心房颤动(简称房颤)经导 管消融治疗的主流策略之一[1-3]。环肺静脉前庭消融术中 准确定位肺静脉前庭区域并完整消融、彻底隔离肺静脉 是保证手术成功的关键[4-5]。目前常用的肺静脉前庭定位 手段主要是通过三维电解剖标测(CARTO)结合X射线影 像或CT影像融合等完成，这些方法均是通过解剖指导进 行肺静脉前庭定位、消融[6-7]，消融是否命中房颤赖以维 持的关键部位不得而知。本文采用CARTO标测系统初 标肺静脉前庭区域，通过肺静脉前庭电位指导房颤消 融，以期探讨肺静脉前庭组织学标测指导房颤消融的可 行性及其在房颤消融中的作用。
1Department of Cardiology, Fourth People's Hospital of Jinan, Jinan 250031, Shandong Province, China; 2Department of Cardiology, Hebei People’s Hospital, Shijiazhuang 050051, Hebei Province, China
Correspondence to: Hu Fu-li, Doctor, Associate chief physician, Department of Cardiology, Hebei People’s Hospital, Shijiazhuang 050051, Hebei Province, China hufuli1@126.com
Li Xiao-mei1, Hu Fu-li2, Qi Xiao-yong2, Liu Mei-xia2, Liu Bing1
Abstract BACKGROUND: Presently used pulmonary vein antrum location methods mainly performed by three-dimensional electroanatomy combined with X-ray image or CT image fusion. These methods conducted vein antrum location and ablation by anatomy instructions. It is still poorly understood whether the ablation hit the key part of atrial fibrillation. OBJECTIVE: To explore the feasibility of catheter ablation guided by three-dimensional electroanatomic mapping system in conjunct with pulmonary vein antrum potential in patients with atrial fibrillation . DESIGN, TIME AND SETTING: The verification clinical study was performed at the Department of Cardiology of Jinan Fourth People's Hospital and Hebei People’s Hospital from March 2007 to June 2009. PARTICIPANTS: Fifty-one patients with drugs refractory, paroxysmal atrial fibrillation were included. METHODS: All patients underwent circumferential pulmonary vein antrum ablation guided by three-dimensional electroanatomic mapping system (CARTO) in conjunct with pulmonary vein antrum potential with the endpoint of electrical isolation. Relevant parameters and ablation success rate were observed. MAIN OUTCOME MEASURES: Procedure-related parameters, such as procedure duration, fluoroscopy duration, cumulative success rate and complication were observed. RESULTS: Pulmonary veins were isolated in all 51 patients. The mean procedure duration, fluoroscopy time and radiofrequency ablation duration are respectively (207±36.7) minutes, (38.2±14.3) minutes, (56.4±15.7) minutes. After (17.5±3.8)-months follow-up, forty (78.4%) patients did not have recurrence of atrial fibrillation, atrial flutter or atrial tachycardia. No severe procedure-related complication had happened. CONCLUSION: Pulmonary vein antrum potential can be used as a landmark to define pulmonary vein antrum, that combined with CARTO system to guide pulmonary vein antrum ablation is effective, safety and feasible for catheter ablation of atrial fibrillation.
Li Xiao-mei★, Master, Associate chief physician, Department of Cardiology, Fourth People's Hospital of Jinan, Jinan 250031, Shandong Province, China lzb1967@126.com
通讯作者：胡福 莉，博士，副主任 医师，河北省人民 医院心内科，河北 省石家庄市 050051 hufuli1@126. com
中图分类号:R543.2 文献标识码:A 文章编号:1673-8225 (2009)52-10313-05
收稿日期：2009-10-18 修回日期：2009-11-13 (200910011001/G·Q)
ISSN 1673-8225 CN 21-1539/R CODEN: ZLKHAH
10313
www.CRTER.org
李晓梅，等.三维电解剖标测系统结合肺静脉前庭电位指导心房颤动经导管消融
0 引言
肺静脉前庭是肺静脉和左房相延续的区域，胚胎发 育中由肺静脉与左房融合、吸收逐渐形成，该处肌纤维 走行复杂，可呈环形、纵行或斜行排列，不同肌纤维相 互交错、各向异性明显，激动在此处传导时存在明显延 缓或阻滞，这种特殊的解剖结构不仅与心房颤动(简称房 颤)的发生和维持有关，同时也使得肺静脉前庭电位不同 于肺静脉或心房电位，多表现为碎裂电位或双电位。
李晓梅，胡福莉，齐晓勇，刘美霞，刘兵. 三维电解剖标测系统结合肺静脉前庭电位指导心房颤动经导管消融[J].中国组织
工程研究与临床康复，2009，13(52):10313-10317
[http://www.crter.org http://cn.zglckf.com]
李晓梅1，胡福莉2，齐晓勇2，刘美霞2，刘 兵1
ຫໍສະໝຸດ Baidu
Catheter ablation guided by three-dimensional electroanatomic mapping system in combination with pulmonary vein antrum potential in patients with atrial fibrillation
1 对象和方法
设计：验证性临床试验。 时间及地点：于2007-03/2009-06在济南市第四医 院及河北省人民医院心内科完成。 对象：纳入2007-03/2008-06行导管消融治疗的阵 发性房颤患者51例，在三维电解剖标测系统(CARTO标 测系统，Biosense-Webster Inc.)指导下结合肺静脉前 庭电位指导行环肺静脉前庭消融。其中男34例，女17 例；年龄36~72岁，平均(55.5±12.8)岁。房颤病史0.5~20 年，均有明显症状，且服用2种以上抗心律失常药物治 疗无效。其中12例合并器质性心脏病，包括冠状动脉粥 样硬化性心脏病5例，高血压心室肥厚6例，风湿性心脏 病二尖瓣置换后1例，左心房内径25~54 mm，平均 (41.2±5.6) mm。 所有患者均符合如下纳入标准：①多种抗心律失常 药物治疗无效的阵发性房颤，均有明显的临床症状，除 外甲状腺功能亢进症及其他急性原因引起的房颤。②左 心房前后径≤55 mm。③消融前一两日经食管超声心动 图检查未发现左心房血栓。④既往未曾接受过导管消融 治疗。⑤患者均签写手术知情同意书。 方法：
Received:2009-10-18 Accepted:2009-11-13
1 济南市第四人民 医院心内科，山东 省济南市 250031；2 河北省 人民医院心内科， 河北省石家庄市 050051
李晓梅★，女， 1968 年生，广东 省河源市人，满 族，2003 年河北 医科大学毕业，硕 士，副主任医师， 主要从事起搏和 心脏电生理研究。 lzb1967@126. com
Linchuang Kangfu 2009;13(52):10313-10317.
[http://www.crter.cn http://en.zglckf.com]
摘要 背景：目前常用的肺静脉前庭定位手段主要是通过三维电解剖标测(CARTO)结合 X 射线影像或 CT 影像融合等完成，这些 方法均是通过解剖指导进行肺静脉前庭定位、消融，消融是否命中心房颤动(房颤)赖以维持的关键部位不得而知。 目的：验证三维电解剖标测系统结合肺静脉前庭电位指导房颤经导管消融治疗的可行性。 设计、时间及地点：验证性临床试验，于 2007-03/2009-06 在济南市第四医院及河北省人民医院心内科完成。 对象：纳入药物治疗无效的症状性阵发性房颤患者 51 例。 方法：于 CARTO 标测系统结合肺静脉前庭电位标测指导下行环肺静脉前庭线性消融，消融终点为肺静脉隔离，观察操作 相关参数及消融成功率。 主要观察指标：观察手术操作时间、X 射线照射时间、手术成功率及并发症等操作相关参数。 结果：51 例患者均实现消融终点。平均操作时间(207±36.7) min，透视时间(38.2±14.3) min，消融时间(56.4±15.7) min。 经过(17.5±3.8)个月的随访，累计 40 例(78.4%)无房颤、心房扑动及房性心动过速等心律失常发生。无严重操作相关并发症 发生。 结论：肺静脉前庭电位标测有助于肺静脉前庭的解剖定位，结合三维电解剖系统指导房颤消融效果好，安全性高，方法可 行。 关键词：心房颤动；导管消融；电解剖标测；肺静脉前庭；心内电图；数字化医学
中国组织工程研究与临床康复 第 13 卷 第 52 期 2009–12–24 出版 Journal of Clinical Rehabilitative Tissue Engineering Research December 24, 2009 Vol.13, No.52
临床医学
三维电解剖标测系统结合肺静脉前庭电位指导心房颤动经导管消融★
Li XM, Hu FL, Qi XY, Liu MX, Liu B. Catheter ablation guided by three-dimensional electroanatomic mapping system in
combination with pulmonary vein antrum potential in patients with atrial fibrillation. Zhongguo Zuzhi Gongcheng Yanjiu yu
环肺静脉前庭消融是目前心房颤动(简称房颤)经导 管消融治疗的主流策略之一[1-3]。环肺静脉前庭消融术中 准确定位肺静脉前庭区域并完整消融、彻底隔离肺静脉 是保证手术成功的关键[4-5]。目前常用的肺静脉前庭定位 手段主要是通过三维电解剖标测(CARTO)结合X射线影 像或CT影像融合等完成，这些方法均是通过解剖指导进 行肺静脉前庭定位、消融[6-7]，消融是否命中房颤赖以维 持的关键部位不得而知。本文采用CARTO标测系统初 标肺静脉前庭区域，通过肺静脉前庭电位指导房颤消 融，以期探讨肺静脉前庭组织学标测指导房颤消融的可 行性及其在房颤消融中的作用。
1Department of Cardiology, Fourth People's Hospital of Jinan, Jinan 250031, Shandong Province, China; 2Department of Cardiology, Hebei People’s Hospital, Shijiazhuang 050051, Hebei Province, China
Correspondence to: Hu Fu-li, Doctor, Associate chief physician, Department of Cardiology, Hebei People’s Hospital, Shijiazhuang 050051, Hebei Province, China hufuli1@126.com
Li Xiao-mei1, Hu Fu-li2, Qi Xiao-yong2, Liu Mei-xia2, Liu Bing1
Abstract BACKGROUND: Presently used pulmonary vein antrum location methods mainly performed by three-dimensional electroanatomy combined with X-ray image or CT image fusion. These methods conducted vein antrum location and ablation by anatomy instructions. It is still poorly understood whether the ablation hit the key part of atrial fibrillation. OBJECTIVE: To explore the feasibility of catheter ablation guided by three-dimensional electroanatomic mapping system in conjunct with pulmonary vein antrum potential in patients with atrial fibrillation . DESIGN, TIME AND SETTING: The verification clinical study was performed at the Department of Cardiology of Jinan Fourth People's Hospital and Hebei People’s Hospital from March 2007 to June 2009. PARTICIPANTS: Fifty-one patients with drugs refractory, paroxysmal atrial fibrillation were included. METHODS: All patients underwent circumferential pulmonary vein antrum ablation guided by three-dimensional electroanatomic mapping system (CARTO) in conjunct with pulmonary vein antrum potential with the endpoint of electrical isolation. Relevant parameters and ablation success rate were observed. MAIN OUTCOME MEASURES: Procedure-related parameters, such as procedure duration, fluoroscopy duration, cumulative success rate and complication were observed. RESULTS: Pulmonary veins were isolated in all 51 patients. The mean procedure duration, fluoroscopy time and radiofrequency ablation duration are respectively (207±36.7) minutes, (38.2±14.3) minutes, (56.4±15.7) minutes. After (17.5±3.8)-months follow-up, forty (78.4%) patients did not have recurrence of atrial fibrillation, atrial flutter or atrial tachycardia. No severe procedure-related complication had happened. CONCLUSION: Pulmonary vein antrum potential can be used as a landmark to define pulmonary vein antrum, that combined with CARTO system to guide pulmonary vein antrum ablation is effective, safety and feasible for catheter ablation of atrial fibrillation.
Li Xiao-mei★, Master, Associate chief physician, Department of Cardiology, Fourth People's Hospital of Jinan, Jinan 250031, Shandong Province, China lzb1967@126.com
通讯作者：胡福 莉，博士，副主任 医师，河北省人民 医院心内科，河北 省石家庄市 050051 hufuli1@126. com
中图分类号:R543.2 文献标识码:A 文章编号:1673-8225 (2009)52-10313-05
收稿日期：2009-10-18 修回日期：2009-11-13 (200910011001/G·Q)
ISSN 1673-8225 CN 21-1539/R CODEN: ZLKHAH
10313
www.CRTER.org
李晓梅，等.三维电解剖标测系统结合肺静脉前庭电位指导心房颤动经导管消融
0 引言
肺静脉前庭是肺静脉和左房相延续的区域，胚胎发 育中由肺静脉与左房融合、吸收逐渐形成，该处肌纤维 走行复杂，可呈环形、纵行或斜行排列，不同肌纤维相 互交错、各向异性明显，激动在此处传导时存在明显延 缓或阻滞，这种特殊的解剖结构不仅与心房颤动(简称房 颤)的发生和维持有关，同时也使得肺静脉前庭电位不同 于肺静脉或心房电位，多表现为碎裂电位或双电位。