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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。
Objective To investigate the effectiveness of three-dimensional electrocardiographic (CARTO) system reconstructed images and pre-acquired magnetic resonance imaging to guide catheter ablation of atrial fibrillation (AF). Methods From September 2005 to September 2006, 100 consecutive patients with atrial fibrillation who did not receive drug therapy were treated with catheter ablation. The basic strategies were linear ablation of the pulmonary vein and electrical isolation under the guidance of CARTO system. Randomly divided into two groups, 50 cases in each group. The first group was the preoperative registration group, the image registration and fusion were performed before the start of ablation, the catheter was ablated under the guidance of this fusion image, and the fusion was performed again after ablation; the second group was the postoperative registration group, In a simple CARTO technology under the guidance of ablation, ablation after the end of the image registration and fusion. Finally, the ablation results of the two groups were compared and the differences in the ablation procedure were evaluated. Results After the termination of circumferential pulmonary vein, the mean distances between the left atrium surface remodeling images and the electroanatomical mapping images in the first group were (1.6 ± 0.7) mm and (75 ± 27) on the ablation lines respectively, The average fluoroscopy time was (31 ± 21) min. The above indexes in group 2 were (2.1 ± 1.3) mm, (98 ± 38) and (55 ± 29) min, respectively. The differences between the above groups were statistically significant. Comparing the actual ablation line with the scheduled ablation line, the differences in group 2 between the two groups were left ventricular topography (15 cases), bottom (11 cases), anterior inferior margin (23 cases), anterior superior margin (24 cases) and posterior superior vestibular margin of the right pulmonary veins (12 cases), the bottom (10 cases) and the anterior inferior border (15 cases). Conclusion Video fusion technique can guide the catheter ablation to improve the accuracy and reduce the X-ray fluoroscopy time and ablation points.