Tsuji Toshihiko, Aoyama Daisetsu, Ishida Tomokazu, Nomura Ryohei, Kakehashi Shota, Mukai Moe, Hasegawa Kanae, Uzui Hiroyasu, Tada Hiroshi
Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Department of Radiography, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Pacing Clin Electrophysiol. 2023 Dec;46(12):1526-1535. doi: 10.1111/pace.14842. Epub 2023 Oct 29.
Preprocedural detection of the running course of the right pericardiophrenic bundles (PBs) is considered to be useful in preventing phrenic nerve (PN) injury during catheter ablation for atrial fibrillation (AF). However, previous studies using the arterial phase of contrast-enhanced computed tomography (CT) reported a relatively low right PBs detection rate.
This study included 63 patients with AF who underwent catheter ablation and preoperative contrast-enhanced CT imaging of the venous and arterial phases (66.7 ± 10.2 years; 44 male). The venous phase of contrast-enhanced CT significantly improved the detection rate of PBs compared to the arterial phase (96.8% vs. 60.3%, p < .001), and PBs were detected in the venous phase only in 23 (36.7%) patients. No significant differences were observed between the right PBs detection rate using non-contrast CT versus the arterial phase of contrast-enhanced CT (p = .37). Patients without visualization of the right PBs during the arterial phase had a higher frequency of chronic heart failure (p = .0083), lower left ventricular ejection fraction (p = .021), and a higher CHADS score (p = .048) than those with visualization. In five patients whose right PBs could only be detected during the venous phase of contrast-enhanced CT, the reconstructed running course of the right PBs corresponded with the PN generated by electrical high-output pacing.
Contrast-enhanced CT images of the venous phase, rather than the arterial phase, are useful in detecting the right PBs, especially in patients with heart failure or reduced left ventricular ejection fraction.
术前检测右心包膈束（PBs）的走行被认为有助于预防心房颤动（AF）导管消融术中膈神经（PN）损伤。然而，以往使用对比增强计算机断层扫描（CT）动脉期的研究报告右PBs检出率相对较低。
本研究纳入63例接受导管消融及术前静脉期和动脉期对比增强CT成像的AF患者（66.7±10.2岁；男性44例）。与动脉期相比，对比增强CT静脉期显著提高了PBs的检出率（96.8%对60.3%，p<0.001），仅在23例（36.7%）患者的静脉期检测到PBs。非增强CT与对比增强CT动脉期的右PBs检出率无显著差异（p=0.37）。动脉期未显示右PBs的患者比显示右PBs的患者慢性心力衰竭发生率更高（p=0.0083），左心室射血分数更低（p=0.021），CHADS评分更高（p=0.048）。在5例仅在对比增强CT静脉期检测到右PBs的患者中，右PBs的重建走行与高输出电起搏产生的PN相对应。
对比增强CT静脉期图像而非动脉期图像有助于检测右PBs，尤其是在心力衰竭或左心室射血分数降低的患者中。
