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目的:报告应用Carto-Merge技术指导阵发性心房颤动(PAf)导管消融的初步经验。方法:20例药物治疗无效的PAf患者,术前1~3d行64排CT成像检查获取左心房和肺静脉的影像数据。进行1次房间隔穿刺后放入2根房间隔穿刺鞘,分别用于置入Lasso导管和Carto灌注消融导管。先用三维电解剖标测系统,建立左心房和肺静脉的三维电解剖结构图,然后利用Carto-Merge软件包的标记点融合和表面融合,将左心房及肺静脉的CT图像与电解剖标测成像进行整合,在整合图上沿肺静脉口外0.5~1.0cm的左心房环肺静脉隔离消融。结果:左心房的构建图与CT图像各对应点的平均距离为(1.64±0.18)mm。共完成消融环40个,40对肺静脉全部实现电隔离,手术时间平均为(170.51±38.47)min。随访1~7个月,18例均无PAf发作,2例发作次数明显减少。所有患者术中术后均无严重并发症。结论:Carto-Merge技术指导PAf的射频消融安全、有效。
OBJECTIVE: To report the initial experience with Carto-Merge technique for catheter ablation of paroxysmal atrial fibrillation (PAf). Methods: Twenty patients with PAf who were ineffective in medical therapy were examined with 64-slice CT imaging 1 ~ 3 days before surgery to obtain the image data of left atrium and pulmonary vein. After atrial septal puncture into the 2 atrial septal puncture sheath, respectively, for the implantation of Lasso catheter and Carto perfusion ablation catheter. Three-dimensional electroanatomical mapping system was used to establish the three-dimensional anatomy of the left atrium and pulmonary veins. Then the CT images of the left atrium and pulmonary veins were compared with the electroanatomic mapping using Carto-Merge software package Integration, in the integration map along the pulmonary vein outside the 0.5 ~ 1.0cm left atrial ring pulmonary vein ablation. Results: The mean distance between the left atrium and CT images was (1.64 ± 0.18) mm. A total of 40 ablation rings were completed, and all 40 pulmonary veins were electrically isolated. The average operation time was (170.51 ± 38.47) min. All cases were followed up for 1 ~ 7 months. No PAf attack was found in 18 cases, and the number of attacks in 2 cases was significantly decreased. All patients had no serious postoperative complications. Conclusion: The Carto-Merge technique is an effective guide to radiofrequency ablation of PAf.