Okumura Yasuo, Henz Benhur D, Johnson Susan B, Bunch T Jared, O'Brien Christine J, Hodge David O, Altman Andres, Govari Assaf, Packer Douglas L
Translational Cardiac Electrophysiology Laboratory, Mayo Clinic, Rochester, Minn., USA.
Circ Arrhythm Electrophysiol. 2008 Jun 1;1(2):110-9. doi: 10.1161/CIRCEP.108.769935. Epub 2008 Apr 30.
Multiple factors create discrepancies between electroanatomic maps and merged, preacquired computed tomographic images used in guiding atrial fibrillation ablation. Therefore, a Carto-based 3D ultrasound image system (Biosense Webster Inc) was validated in an animal model and tested in 15 atrial fibrillation patients.
Twelve dogs underwent evaluation using a newly developed Carto-based 3D ultrasound system. After fiducial clip markers were percutaneously implanted at critical locations in each cardiac chamber, 3D ultrasound geometries, derived from a family of 2D intracardiac echocardiographic images, were constructed. Point-source error of 3D ultrasound-derived geometries, assessed by actual real-time 2D intracardiac echocardiographic clip sites, was 2.1+/-1.1 mm for atrial and 2.4+/-1.2 mm for ventricular sites. These errors were significantly less than the variance on CartoMerge computed tomographic images (atria: 3.3+/-1.6 mm; ventricles: 4.8+/-2.0 mm; P<0.001 for both). Target ablation at each clip, guided only by 3D ultrasound-derived geometry, resulted in lesions within 1.1+/-1.1 mm of the actual clips. Pulmonary vein ablation guided by 3D ultrasound-derived geometry resulted in circumferential ablative lesions. Mapping in 15 patients produced modestly smaller 3D ultrasound versus electroanatomic map left atrial volumes (98+/-24 cm(3) versus 109+/-25 cm(3), P<0.05). Three-dimensional ultrasound-guided pulmonary vein isolation and linear ablation in these patients were successfully performed with confirmation of pulmonary vein entrance/exit block.
These data demonstrate that 3D ultrasound images seamlessly yield anatomically accurate chamber geometries. Image volumes from the ultrasound system are more accurate than possible with CartoMerge computed tomographic imaging. This clinical study also demonstrates the initial feasibility of this guidance system for ablation in patients with atrial fibrillation.
多种因素导致在指导心房颤动消融时使用的电解剖图与预先获取并融合的计算机断层扫描图像之间存在差异。因此，一种基于Carto的三维超声图像系统（Biosense Webster公司）在动物模型中得到验证，并在15例心房颤动患者中进行了测试。
12只犬使用新开发的基于Carto的三维超声系统进行评估。在每个心腔内的关键位置经皮植入基准夹标记后，根据一系列二维心内超声心动图图像构建三维超声几何结构。通过实际实时二维心内超声心动图夹位点评估的三维超声衍生几何结构的点源误差，心房部位为2.1±1.1毫米，心室部位为2.4±1.2毫米。这些误差显著小于CartoMerge计算机断层扫描图像上的差异（心房：3.3±1.6毫米；心室：4.8±2.0毫米；两者P均<0.001）。仅在三维超声衍生几何结构的引导下，对每个夹子进行靶向消融，消融灶位于实际夹子1.1±1.1毫米范围内。由三维超声衍生几何结构引导的肺静脉消融产生了环形消融灶。对15例患者进行的标测显示，与电解剖图相比，三维超声测量的左心房容积略小（98±24立方厘米对109±25立方厘米，P<0.05）。在这些患者中成功进行了三维超声引导下的肺静脉隔离和线性消融，并证实了肺静脉入口/出口阻滞。
这些数据表明，三维超声图像能够无缝生成解剖学上准确的心腔几何结构。超声系统的图像容积比CartoMerge计算机断层扫描成像更准确。这项临床研究还证明了该引导系统用于心房颤动患者消融的初步可行性。
