Chu E, Kalman J M, Kwasman M A, Jue J C, Fitzgerald P J, Epstein L M, Schiller N B, Yock P G, Lesh M D
Department of Medicine, University of California, San Francisco 94143-1354.
J Am Coll Cardiol. 1994 Nov 1;24(5):1351-7. doi: 10.1016/0735-1097(94)90119-8.
The purpose of this study was to describe our preliminary experience using catheter-based intracardiac echocardiography as an adjunct to biplane fluoroscopy for guiding radiofrequency catheter ablation of atrial arrhythmias in the right side of the heart.
Catheter ablation requires precise positioning and stable ablation electrode-endocardial contact. This procedure is currently guided by an analysis of intracardiac electrograms and fluoroscopy. However, the use of fluoroscopy does not allow the endocardium and certain anatomic landmarks to be identified and is associated with the hazards of radiation exposure.
Seventeen symptomatic patients were studied. A 10F 10-MHz intracardiac imaging catheter was used to visualize specific anatomic landmarks in the right atrium for directing the ablation electrode in 15 patients undergoing radiofrequency ablation of 19 arrhythmias and to assist with interatrial septal puncture in 3 patients.
Continuous intracardiac imaging was performed for a mean +/- SD of 63.6 +/- 39.2 min and demonstrated distal electrode-endocardial tissue contact in 81 (60%) of 134 radiofrequency applications. Movement of the catheter was demonstrated during 36 (44%), microcavitations during 39 (48%) and thrombus during 15 (19%) of the 81 imaged applications. In 7 of 10 procedures for atrial flutter, successful ablation was directed at anatomic corridors in the right atrium visualized with intracardiac echocardiography. During ablation of atrial tachycardia, imaging identified abnormal atrial anatomy related to previous surgery and guided successful ablation of a reentrant tachycardia circulating around these anatomic obstacles. In two procedures for slow pathway modification of atrioventricular node reentrant tachycardia, intracardiac echocardiography confirmed catheter stability at the tricuspid annulus anterior to the coronary sinus.
During catheter ablation, intracardiac echocardiography augments fluoroscopy by visualizing anatomic landmarks, ensuring stable endocardial contact and assisting in transseptal puncture. Ablation of typical atrial flutter can be successfully directed at anatomic corridors identified using intracardiac imaging.
本研究旨在描述我们使用心内超声心动图作为双平面荧光透视辅助手段，指导心脏右侧房性心律失常射频导管消融的初步经验。
导管消融需要精确的定位以及稳定的消融电极与心内膜接触。目前该操作通过分析心内电图和荧光透视来指导。然而，荧光透视的使用无法识别心内膜和某些解剖标志，且存在辐射暴露风险。
对17例有症状的患者进行研究。使用一根10F 10兆赫的心内成像导管，在15例接受19次心律失常射频消融的患者中，用于观察右心房的特定解剖标志以指导消融电极，在3例患者中辅助房间隔穿刺。
心内连续成像的平均时间（±标准差）为63.6±39.2分钟，在134次射频应用中有81次（60%）显示远端电极与心内膜组织接触。在81次成像应用中，36次（44%）显示导管移动，39次（48%）显示微泡形成，15次（19%）显示血栓形成。在10例房扑消融手术中的7例中，成功消融是针对心内超声心动图显示的右心房解剖通道进行的。在房性心动过速消融过程中，成像识别出与既往手术相关的异常心房解剖结构，并指导成功消融围绕这些解剖障碍循环的折返性心动过速。在两例房室结折返性心动过速慢径路改良手术中，心内超声心动图证实导管在冠状窦前方的三尖瓣环处稳定。
在导管消融过程中，心内超声心动图通过显示解剖标志、确保稳定的心内膜接触以及辅助经间隔穿刺来增强荧光透视。典型房扑的消融可以成功地针对使用心内成像识别出的解剖通道进行。
