Gepstein L, Wolf T, Hayam G, Ben-Haim S A
Cardiovascular System Laboratory, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
Pacing Clin Electrophysiol. 2001 Nov;24(11):1672-8. doi: 10.1046/j.1460-9592.2001.01672.x.
Catheter-based continuous linear lesions may become a curative procedure for AF. The accuracy of guiding the application of continuous RF lesions by a nonfluoroscopic mapping system (NFM) during AF in goats was tested. The NFM system (Carto) uses magnetic fields to determine, in real time, the location and orientation of a 7 Fr ablation catheter tip. AF was induced in nine goats by intravenous infusion of methacholine (3-4 microg x kg(-1) min(-1)) and burst pacing. The three-dimensional atrial geometry was reconstructed using the median location of the mapping catheter tip during 30 seconds when in contact with each endocardial site. Sequential RF energy (60 seconds in a temperature-controlled mode [60 degrees C]) was delivered along a predetermined path to create longitudinal lesions in both atria. Sites to which RF energy was applied were tagged on the NFM map, enabling the operator to accurately navigate the catheter tip to the adjacent sites. In all cases (n = 14) the location, shape, length, and continuity of the linear lesions on the electroanatomic maps highly correlated with the autopsy findings. Average line length on the reconstructed maps was 32.3+/-4.1 mm, which highly correlated (r = 0.98, P<.001) with the lesions created in the pathological specimen (31.7+/-3.9 mm). The NFM system can guide the application of RF linear lesions in a highly accurate manner during AF. Moreover, the ability to tag the ablation sites on the three-dimensional maps together with real-time monitoring of the ablation catheter tip location enables delivery of RF energy to create reproducible, continuous, longitudinal lesions without the use of fluoroscopy.
基于导管的连续性线性损伤可能成为治疗房颤的一种方法。我们测试了在山羊房颤期间，通过非荧光透视标测系统（NFM）引导连续性射频损伤应用的准确性。NFM系统（Carto）利用磁场实时确定一根7F消融导管尖端的位置和方向。通过静脉输注乙酰甲胆碱（3 - 4μg·kg⁻¹·min⁻¹）和短阵快速刺激诱发9只山羊发生房颤。在标测导管尖端与每个心内膜部位接触的30秒内，利用其中心位置重建三维心房几何结构。沿预定路径依次输送射频能量（温控模式下60秒，60℃），在双心房制造纵向损伤。在NFM地图上标记施加射频能量的部位，使操作者能够将导管尖端精确导航至相邻部位。在所有病例（n = 14）中，电解剖图上线性损伤的位置、形状、长度和连续性与尸检结果高度相关。重建图上的平均线条长度为32.3±4.1mm，与病理标本中制造的损伤（31.7±3.9mm）高度相关（r = 0.98，P<0.001）。NFM系统能够在房颤期间以高度准确的方式引导射频线性损伤的应用。此外，在三维地图上标记消融部位的能力以及对消融导管尖端位置的实时监测，使得在不使用荧光透视的情况下能够输送射频能量，制造可重复、连续的纵向损伤。
