Khaykin Yaariv, Skanes Allan, Whaley Bonnie, Hill Carol, Beardsall Marianne, Seabrook Catherine, Wulffhart Zaev, Oosthuizen Richard, Gula Lorne, Verma Atul
Southlake Regional Health Center, Newmarket, Ontario, Canada.
Heart Rhythm. 2008 Oct;5(10):1396-402. doi: 10.1016/j.hrthm.2008.06.025. Epub 2008 Jul 3.
Ablation of left ventricular tachycardia (LV VT) involves point-by-point reconstruction of the three-dimensional (3D) virtual anatomy. It is time consuming and requires substantial fluoroscopy exposure. Two-dimensional (2D) intracardiac echocardiography (ICE) affords real-time imaging of the cardiac structures.
This study sought to evaluate a mapping system integrating ICE with 3D mapping to guide VT ablation.
Seventeen patients (16 men, 62 +/- 11 years, LV ejection fraction 40% +/- 15%) had ablation of nonidiopathic VT guided using a system integrating 3D mapping and ICE. ICE probe with a location sensor tracked by the mapping system was positioned in the right heart. Endocardial contours traced on gated images of the LV were used to generate a registered 3D map. Regional wall motion abnormalities (WMA) were tagged.
3D maps were created in 26 +/- 8 min, before entering the LV and without fluoroscopy. Maps were built from 23 +/- 7 contours. Regional WMA corresponded to low bipolar voltage (<0.5 mV). Procedure time was 240 +/- 77 min, with fluoroscopy time of 25 +/- 12 min. LV volume by ICE was 172 +/- 119 cm(3) versus 164 +/- 112 cm(3) for the point-by-point maps (P = .5). Scar area by ICE was 33 +/- 32 cm(2) versus 36 +/- 33 cm(2) for voltage mapping (P = .4). At 5 +/- 4 months, 12 patients (71%) were free of VT.
A system combining 2D ICE and 3D mapping can reconstruct a 3D shell of the LV, including a substrate map based on regional WMA without the need to enter the LV. VT ablation guided using this approach is safe and effective.
左心室心动过速（LV VT）的消融涉及三维（3D）虚拟解剖结构的逐点重建。这很耗时，并且需要大量的透视曝光。二维（2D）心内超声心动图（ICE）可对心脏结构进行实时成像。
本研究旨在评估一种将ICE与3D标测相结合以指导VT消融的标测系统。
17例患者（16例男性，年龄62±11岁，左心室射血分数40%±15%）接受了使用3D标测和ICE相结合的系统指导的非特发性VT消融。带有由标测系统跟踪的位置传感器的ICE探头置于右心。在左心室门控图像上追踪的心内膜轮廓用于生成配准的3D地图。标记了局部室壁运动异常（WMA）。
在未进入左心室且无透视的情况下，26±8分钟内创建了3D地图。地图由23±7个轮廓构建而成。局部WMA对应于低双极电压（<0.5 mV）。手术时间为240±77分钟，透视时间为25±12分钟。ICE测量的左心室容积为172±119 cm³，逐点地图测量的左心室容积为164±112 cm³（P = 0.5）。ICE测量的瘢痕面积为33±32 cm²，电压标测测量的瘢痕面积为36±33 cm²（P = 0.4）。在5±4个月时，12例患者（71%）无VT发作。
结合2D ICE和3D标测的系统可以重建左心室的3D外壳，包括基于局部WMA的基质图，而无需进入左心室。使用这种方法指导的VT消融安全有效。
