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目的探讨Cartomerge技术联用单根Lasso导管指导心房颤动(简称房颤)射频导管消融的安全性和有效性。方法对2006年5月至2008年8月在广西医科大学第一附属医院接受治疗的40例房颤患者用Cartomerge技术指导射频导管消融治疗房颤。术中用Carto导管标测和构建左心房和肺静脉的电解剖图,然后与术前心脏CT造影的三维图像进行数据整合形成二者的复合图形(Cartomerge)。在Cartomerge的指导下对房颤患者行环绕同侧肺静脉的线性消融,射频消融终点为Lasso导管标测证实所有肺静脉均达到电隔离效果。如房颤不终止,依次进一步消融左房顶部线、二尖瓣峡部线及三尖瓣峡部线,如上述部位消融后房颤仍未终止,予静脉注射普罗帕酮70mg,不能复律时,行同步直流电复律恢复窦性心律。结果40例房颤均达到射频消融终点。手术时间是(255.0±79.45)min,曝光时间是(43.0±19.05)min。未发生心脏穿孔和肺静脉狭窄等严重并发症,其中28例患者经4～14个月随访均维持窦性心律,近期手术成功率为70%。结论联合应用Cartomerge技术和单根Lasso导管指导进行房颤射频导管消融安全有效,可简化操作,提高消融手术的成功率,并且减少X线曝光时间。
Objective To explore the safety and effectiveness of Cartomerge technique combined with single Lasso catheter in guiding the radiofrequency ablation of atrial fibrillation (AF). Methods A total of 40 patients with atrial fibrillation who were treated at the First Affiliated Hospital of Guangxi Medical University from May 2006 to August 2008 were enrolled in this study. Cartomerge technique was used to guide the treatment of atrial fibrillation by radiofrequency catheter ablation. Intraoperative carto catheter mapping and construction of the left atrium and pulmonary vein electrical dissection map, and then with the preoperative cardiac CT three-dimensional image data integration to form a composite of the two figures (Cartomerge). A linear ablation of ipsilateral pulmonary veins was performed in patients undergoing atrial fibrillation under the guidance of Cartomerge. Lasso catheterization of the endpoint of radiofrequency ablation confirmed that all pulmonary veins achieved electrical isolation. Such as atrial fibrillation is not terminated, followed by further ablation of the left atrium top line, mitral valve isthmus line and the tricuspid valve isthmus line, such as the above site ablation after atrial fibrillation has not yet terminated, intravenous propafenone 70mg, can not be a cardioversion, Row synchronized DC cardioversion of sinus rhythm. Results 40 cases of atrial fibrillation reached the end of radiofrequency ablation. The operation time was (255.0 ± 79.45) min and the exposure time was (43.0 ± 19.05) min. No serious complications such as cardiac perforation and pulmonary venous stenosis occurred. Among them, 28 patients were followed up for 4 to 14 months to maintain sinus rhythm. The success rate of the recent operation was 70%. Conclusion The combined application of Cartomerge technique and single Lasso catheter is safe and effective for radiofrequency ablation of atrial fibrillation, which can simplify the operation, improve the success rate of ablation and reduce the X-ray exposure time.