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目的在左房内精准有效操控消融导管是保证心房颤动(简称房颤)消融高效成功的技术关键。我们根据圆规画圆原理设计了新型轴支撑消融导管,本实验拟验证其是否具有精准有效的操控性。方法将同一实验动物先后随机分入实验组和对照组,分别采用轴支撑冷盐水灌注消融导管(轴支撑组)和非轴支撑冷盐水灌注消融导管(非轴支撑组)进行右上肺静脉标测/消融操作。将轴支撑导管的轴支撑钢丝撤回钢丝腔内即成为非轴支撑导管。采用EnSite Velocity~(TM)心脏三维标测系统重建左房及右上肺静脉。实验内容包括导管在右上肺静脉邻近区域的贴靠标测及标测消融两部分。结果 8只动物中,房间隔穿刺致2例动物心包压塞,1例死亡,7例动物完成实验程序。在贴靠标测实验中,轴支撑组完成环肺静脉间断贴靠、环肺静脉连续贴靠和肺静脉前庭放射状线性连续贴靠的操作时间和曝光时间分别显著少于非轴支撑组(P均<0.001);在标测消融实验中,完成环肺静脉消融和肺静脉前庭放射状线性消融的操作时间和曝光时间分别显著少于非轴支撑组(P均<0.001)。在左房操作过程中,轴支撑组不经意退回右房的次数显著少于非轴支撑组[(0.7±0.8)次vs(5.1±1.3)次,P<0.001];轴支撑组从原房间隔穿刺孔再进入左房的时间显著少于非轴支撑组[(1.0±0.2)min vs(5.0±0.9)min,P<0.001]。动物解剖未见留置在肺静脉及左房内的导引钢丝表面及导管钢丝腔开口有血栓附着,右上肺静脉内膜未见划痕、撕裂和血栓附着。结论轴支撑消融导管的操控性能明显优于非轴支撑导管。轴支撑导管的移动方向及移动距离易于控制,到位精准,贴靠标测稳定,具有较高的安全性。
The purpose of accurate and effective control of the left atrial catheter ablation is to ensure the success of atrial fibrillation (abortion) ablation of the key technology. According to the principle of compasses, we designed a new type of axial support ablation catheter, this experiment to verify whether it has precise and effective controllability. Methods The same experimental animal was randomly divided into experimental group and control group. The right upper pulmonary vein index / right pulmonary vein catheterization was performed by using axial saline-water perfusion and ablation catheter (axial support group) and non-axial support cold saline perfusion and ablation catheter (non-axial support group) Ablation operation. Axis support shaft of the shaft support wire withdrawal wire cavity that is non-axial support catheter. Reconstruction of left atrium and right superior pulmonary vein with EnSite Velocity ™ (TM) Cardiac 3D mapping system. Experimental contents include the catheter in the right upper pulmonary vein in the vicinity of the mapping and mapping ablation two parts. Results In 8 animals, atrial septal puncture caused 2 cases of animal pericardial occlusion, 1 died, and 7 animals completed the experimental procedure. In the abutment mapping test, the operation time and the exposure time of the shaft support group for discontinuity and contact of the circumferential pulmonary vein were significantly less than those of the non-axial support group (P <0.001, respectively) ). In the mapping ablation experiment, the operation time and exposure time of circumferential pulmonary vein ablation and pulmonary vestibular radial ablation were significantly less than those of non-axial support group (all P <0.001). In the left atrium operation, the number of inadvertent axial support group returned to the right atrium was significantly less than that in the non-axial support group ([0.7 ± 0.8] vs (5.1 ± 1.3), P <0.001] The puncture time to enter the left atrium was significantly less than that in the non-axial group [(1.0 ± 0.2) min vs (5.0 ± 0.9) min, P <0.001]. Animal anatomy did not stay in the pulmonary vein and left atrial guide wire surface and the catheter wire opening thrombosis, the right upper pulmonary veins no scratches, tears and thrombus attachment. Conclusion The operation performance of the shaft-supported ablation catheter is obviously superior to that of the non-shaft-supported catheter. The direction and moving distance of the shaft supporting catheter are easy to control, precise in place, stable against the mapping, with high safety.