Khaykin Yaariv, Skanes Allan, Wulffhart Zaev A, Gula Lorne, Whaley Bonnie, Oosthuizen Richard, Seabrook Catherine, Beardsall Marianne, Verma Atul
Heart Rhythm Program, Southlake Regional Health Center, Newmarket, ON, Canada.
London Health Sciences Center.
J Atr Fibrillation. 2008 Jul 16;1(2):32. doi: 10.4022/jafib.32. eCollection 2008 Jul-Aug.
Catheter ablation of atrial fibrillation (AF) is typically guided by 3D mapping. This involves point-by-point reconstruction of the 3D virtual anatomy and may be time consuming and require substantial fluoroscopy exposure. Intracardiac echocardiography (ICE) affords real time imaging of the cardiac structures during mapping and ablation. Between February and May 2007, 15 patients (100% men, 10 with paroxysmal AF) presenting for AF ablation were offered mapping using a novel system integrating 3D mapping and ICE. A modified ICE probe with a location sensor tracked by the mapping system was positioned in the right atrium (RA). This allowed acquisition of ECG gated images of the left atrium (LA). Endocardial contours were traced on each image and were used to generate a registered 3D map. 3D maps took a mean of 51+/-25 minutes to create, PRIOR to entering the LA and without fluoroscopy. Pulmonary veins and the esophagus were rendered in 3D. A complete map was built from a mean of 46+/-19 contours. Upon instrumentation of the left atrium, the maps were easily distorted if points collected by the mapping catheter were combined with the original map, due to deformation of the left atrial geometry by the relatively stiff ablation catheter. Pulmonary vein antrum isolation was guided by a circular mapping catheter. Since this catheter could not be visualized on the CARTO map, fluoroscopy was used to track its position and the contact between the ablation catheter and the circular mapping catheter. No substantial reduction in fluoroscopy time was thus realized, as expected. At 10+/-1 months of followup, 73% of the patients were in sinus rhythm after the initial three month blanking period. No patient suffered any complications related to the procedure or in follow-up. A mapping system combining ICE and 3D electroanatomical mapping can feasibly reconstruct a 3D shell of the LA and the pulmonary veins without the need to enter the left heart. The map created is sensitive to distortion during point-by-point mapping with the standard ablation catheter.
心房颤动（AF）的导管消融通常由三维标测引导。这涉及对三维虚拟解剖结构进行逐点重建，可能耗时且需要大量的透视暴露。心腔内超声心动图（ICE）可在标测和消融过程中对心脏结构进行实时成像。在2007年2月至5月期间，15例接受AF消融的患者（100%为男性，10例为阵发性AF）被提供使用一种整合了三维标测和ICE的新型系统进行标测。一个带有由标测系统跟踪的位置传感器的改良ICE探头被置于右心房（RA）。这使得能够采集左心房（LA）的心电图门控图像。在每张图像上描绘心内膜轮廓，并用于生成配准的三维地图。在进入左心房之前且无需透视的情况下，创建三维地图平均耗时51±25分钟。肺静脉和食管以三维形式呈现。平均由46±19个轮廓构建出完整的地图。在对左心房进行器械操作时，如果将标测导管采集的点与原始地图相结合，由于相对较硬的消融导管会使左心房几何形状变形，地图很容易失真。肺静脉前庭隔离由环形标测导管引导。由于该导管在CARTO地图上不可见，因此使用透视来跟踪其位置以及消融导管与环形标测导管之间的接触。因此，正如预期的那样，透视时间并未显著减少。在随访10±1个月时，73%的患者在最初三个月的空白期后处于窦性心律。没有患者出现与该手术或随访相关的任何并发症。一种结合ICE和三维电解剖标测的标测系统能够在无需进入左心的情况下，可行地重建左心房和肺静脉的三维外壳。所创建的地图在使用标准消融导管进行逐点标测过程中对失真敏感。
