INTRACARDIAC ECHOCARDIOGRAPHY DURING RADIOFREQUENCY CATHETER ABLATION OF CARDIAC-ARRHYTHMIAS IN HUMANS
INTRACARDIAC ECHOCARDIOGRAPHY DURING RADIOFREQUENCY CATHETER ABLATION OF CARDIAC-ARRHYTHMIAS IN HUMANS
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DOI：
10.1016/0735-1097(94)90119-8
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发表时间：
1994-11-01
影响因子：
24
通讯作者：
LESH, MD
中科院分区：
文献类型：
--
作者：
CHU, E;KALMAN, JM;LESH, MD
目标.本研究的目的是描述我们使用基于导管的心内超声心动图作为双平面透视辅助手段指导右心房性心律失常的射频导管消融术的初步经验。导管消融需要精确的定位和稳定的消融电极-内膜接触。该手术目前通过分析心内电描记图和荧光透视来指导。然而，荧光透视的使用不允许内支架和某些解剖标志被识别，并且与辐射照射的危险相关。研究了17例有症状的患者。应用10 F 10-MHz心内成像导管对15例19例心律失常行射频消融术的患者进行右心房内特定解剖标志的显示，以指导消融电极，并对3例患者进行房间隔穿刺。连续心内成像的平均+/- SD为63.6 +/- 39.2 min，在134次射频应用中，81次（60%）显示远端电极-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%）显示微空化，15次（19%）显示血栓。在10例房扑手术中，7例成功消融了心内超声心动图显示的右心房解剖通道。在房性心动过速消融期间，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结构障碍循环的折返性心动过速。在两个房室结折返性心动过速的慢径路改良手术中，经心超声心动图证实导管在冠状窦前的三尖瓣环处稳定。在导管消融期间，心内超声心动图通过可视化解剖标志增强了透视，确保稳定的内膜接触并辅助经房间隔穿刺。典型的心房黄油消融可以成功地直接在解剖走廊确定使用心内成像。
Objectives. The purpose of this study was to describe our reliminary 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.Background. 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.Methods. 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.Results. 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, in tracardiac echocardiography confirmed catheter stability at the tricuspid annulus anterior to the coronary sinus.Conclusions. During catheter ablation, intracardiac echocardiography augments fluoroscopy by visualizing anatomic landmarks, ensuring stable endocardial contact and assisting in transseptal puncture. Ablation of typical atrial butter can be successfully directed at anatomic corridors identified using intracardiac imaging.