Ahmed Jameel, Sohal Sandeep, Malchano Zachary J, Holmvang Godtfred, Ruskin Jeremy N, Reddy Vivek Y
Cardiac Arrhythmia Service, Massachusetts General Hospital-Harvard Medical School, Boston 02114, USA.
J Cardiovasc Electrophysiol. 2006 Mar;17(3):251-5. doi: 10.1111/j.1540-8167.2005.00339.x.
Balloon ablation catheters using various energy sources are being developed to perform pulmonary vein (PV) isolation to treat atrial fibrillation. Prior evaluations of 2D CT/MR images are limited by the frequent elliptical shape of the PV ostia, the nonorthogonal orientation of the PVs to the left atrial (LA) chamber, and difficulty in appreciating through-slice curvature. To provide anatomical data relevant to balloon catheter ablation, 3D surface reconstructions of LA-PVs were generated and analyzed to define ostial architecture and size.
Using MRI datasets obtained from 101 paroxysmal AF patients, the LA-PVs were segmented to generate 3D LA-PV surface reconstructions. Using both external and endoluminal projections, the PV ostial and antral regions were identified and evaluated. In the left PVs, a common left-sided ostium was identified in 94 patients, with an ostial circumference of 95 +/- 15 mm. Branching of the left PVs occurred 0-5 mm away from the common left ostium in 43 patients (43%), 5-15 mm away from the common os in 37 patients (37%), and >15 mm away from the common os in 14 patients (14%). In patients with either distinct left PV ostia, or common os <15 mm (87 patients), the individual LSPV/LIPV ostial circumferences were 67 +/- 12 mm and 58 +/- 9 mm, respectively. Mean left antral circumference was 114 +/- 17 mm. In the right PVs, the ostial circumferences of the RSPV/RIPV were 68 +/- 11 mm and 66 +/- 11 mm, respectively. Mean right antral circumference was 107 +/- 19 mm. Assuming ideal deformation of the LA chamber anatomy, the minimal diameters of a balloon ablation catheter required to isolate 95% of the RSPV, RIPV, LSPV, LIPV, LCPV, left antrum, and right antrum are 29 mm, 28 mm, 29 mm, 24 mm, 40 mm, 46 mm, and 47 mm, respectively.
Analysis of 3D surface reconstructions of LA-PV anatomy reveals that balloon catheter-based ablation of the PVs is likely feasible in most patients, but balloon ablation of the common PV antra would be problematic.
正在研发使用各种能量源的球囊消融导管，以进行肺静脉（PV）隔离来治疗心房颤动。先前对二维CT/MR图像的评估受到肺静脉口常见的椭圆形、肺静脉与左心房（LA）腔的非正交方向以及难以识别贯穿层面曲率的限制。为了提供与球囊导管消融相关的解剖学数据，生成并分析了LA-PV的三维表面重建，以确定口部结构和大小。
使用从101例阵发性房颤患者获得的MRI数据集，对LA-PV进行分割以生成三维LA-PV表面重建。使用外部和腔内投影，识别并评估肺静脉口部和窦部区域。在左肺静脉中，94例患者发现有一个共同的左侧开口，口部周长为95±15mm。43例患者（43%）的左肺静脉分支发生在距共同左开口0-5mm处，37例患者（37%）在距共同开口5-15mm处，14例患者（14%）在距共同开口>15mm处。在左肺静脉口明显不同或共同开口<15mm的患者（87例）中，单个左上肺静脉/左下肺静脉口部周长分别为67±12mm和58±9mm。左窦部平均周长为114±17mm。在右肺静脉中，右上肺静脉/右下肺静脉口部周长分别为68±11mm和66±11mm。右窦部平均周长为107±19mm。假设LA腔解剖结构的理想变形，隔离95%的右上肺静脉、右下肺静脉、左上肺静脉、左下肺静脉、左中肺静脉、左窦部和右窦部所需的球囊消融导管的最小直径分别为29mm、28mm、29mm、24mm、40mm、46mm和47mm。
对LA-PV解剖结构的三维表面重建分析表明，基于球囊导管的肺静脉消融在大多数患者中可能是可行的，但对共同肺静脉窦部进行球囊消融可能存在问题。
