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Title: [Value of two left atrium and pulmonary vein stereoscopic imaging reconstruction methods on guiding radiofrequency ablation for atrial fibrillation].
Author: Tian Y, Zhou S, Yin YH, Zheng YX, Wang RP, Liu XQ, Liu ZQ, Liu QF, Liu W, Pang J, Jiang Z, Tian LH, Huang J, Yang L.
Journal: Zhonghua Xin Xue Guan Bing Za Zhi; 2017 Nov 24; 45(11):930-934. PubMed ID: 29166718.
Abstract:
Objective: To compare the value of two 3D imaging reconstruction methods for left atria and pulmonary vein on guiding the catheter ablation for atrial fibrillation (AF). Methods: From January 2014 to January 2017, a total of 100 drug refractory paroxysmal AF patients were divided into left atria direct angiography group (n=50), and indirect angiography group (n=50). 3D CARTO system was applied for mapping and guiding the ablation procedure. Patients assigned to direct angiography group were treated as follows: intraoperative puncture of atrial septum, inject contrast agent directly into the left atrium, conduct left atrial and pulmonary venous rotation angiography, reconstruct three-dimensional image, integrate the image into real-time X-ray system to facilitate circumferential pulmonary vein isolation. Patients assigned into the indirect angiography group were treated as follows: inject contrast agent through the right ventricle, conduct delayed rotation angiography of the left atria and pulmonary vein to guide circumferential pulmonary vein fixation and ablation. The left atrial and pulmonary venous image acquisition, the operation and X-ray exposure time, the success rate and the incidence of complication of the two groups were compared. The patients were followed up for 3-6 months. Results: General clinical characteristics of the two groups were similar(all P>0.05). Ablation was successful in all 100 patients. The operation time[(112.0±21.4)min vs. (134.0±24.3)min]and X-ray exposure time((10.7±4.7)min vs. (15.8±5.2)min)were significantly lower in direct angiography group than in indirect angiography group (both P<0.01). There was no significant difference between the two groups in the immediate (86%(43/50) vs. 82%(41/50), P=0.59) and short-term (76%(38/50) vs. 72%(36/50), P=0.65) success rate and complication rate (1 aneurysm in the direct angiography group, 1 pericardial tamponade in the indirect angiography group). In-hospital mortality was zero percent. Conclusion: It is safe and effective method to guide the radiofrequency catheter ablation of paroxysmal atrial fibrillation by reconstruction 3D image of left atrium and pulmonary vein. Compared with indirect angiography group, direct angiography group can improve the imaging quality of left atrium and pulmonary vein, decrease the X-ray exposure time of the ablation procedure. 目的： 比较左心房与肺静脉两种立体成像技术指导心房颤动导管消融的安全性及疗效。 方法： 回顾性研究2014年1月至2017年1月入选贵州省人民医院心内科药物治疗无效的阵发性心房颤动患者共100例，分为直接成像组和间接成像组，两组患者均用CARTO三维系统进行标测指导消融。直接成像组(50例)：术中穿刺房间隔，于左心房注入对比剂，同时行左心房、肺静脉造影旋转成像，重建其立体影像并导入实时的X线透视系统，便于环肺静脉隔离。间接成像组(50例)：经右心室注入对比剂，行左心房、肺静脉延迟显影旋转成像，指导环肺静脉定口与消融。观察记录两组左心房肺静脉影像采集，手术操作及X线曝光时间，手术成功率与并发症发生率并随访3～6个月。 结果： 两组患者平均年龄、性别构成及病史长短，左心房大小、左心室收缩功能及合并疾病情况等差异均无统计学意义(P均>0.05)，100例房颤患者均顺利完成了房颤消融术，直接成像组手术操作时间[(112.0±21.4)min比(134.0±24.3)min]及X线曝光时间[(10.7±4.7)min比(15.8±5.2)min]均明显低于间接成像组(P均<0.01)。两组患者的手术即刻成功率[86%(43/50)比82%(41/50)，P＝0.59]及近期成功率[76%(38/50)比72%(36/50)，P＝0.65]差异均无统计学意义。直接成像组1例发生动脉瘤，间接成像组1例发生心包填塞，治疗后均安全出院。 结论： 左心房肺静脉立体影像导入实时X线透视系统指导阵发性心房颤动的射频消融是安全、有效的。直接造影法可提高左心房肺静脉成像质量，减少术中X线曝光量及手术操作时间。.

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