Electroanatomic Mapping and Radiofrequency Ablation of Porcine Left Atria and Atrioventricular Nodes Using Magnetic Resonance Catheter Tracking
Electroanatomic Mapping and Radiofrequency Ablation of Porcine Left Atria and Atrioventricular Nodes Using Magnetic Resonance Catheter Tracking
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DOI：
10.1161/circep.109.882472
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发表时间：
2009-12-01
影响因子：
8.4
通讯作者：
Reddy, Vivek Y.
中科院分区：
文献类型：
--
作者：
Schmidt, Ehud J.;Mallozzi, Richard P.;Reddy, Vivek Y.
背景：mri兼容的电生理系统先前用于磁共振引导下的左心室电解剖测绘，随着改进的磁共振跟踪、磁共振兼容的射频消融系统和更高分辨率的成像序列的增强，可以在较小的心脏结构中进行测绘、消融和消融监测。在左心房（LA）和房室（AV）结进行核磁共振跟踪导航，然后进行左心房电解剖定位和肺静脉（pv）和房室结射频消融。方法与结果：1例心室消融，7例PV消融，3例LA定位，3例房室结消融。使用三种mri兼容设备（消融/定位导管、可转矩护套、刺激/起搏导管），每个设备有4至5个跟踪微线圈。在x线下进行隔穿刺，所有其他程序步骤在MRI中进行。预获取MRI路线图用于实时导管导航。以13帧/秒的速度同时跟踪3个设备。使用追踪式消融导管和导管套进行LA定位和PV射频消融。使用三维心肌延迟增强和死后大体组织检查记录和验证消融点。3头猪中有3头完成了完整的LA电解剖定位，7头猪中有3头完成了右下PV周向消融，由于导管偏转有限导致不完全隔离。房室结消融期间行心室起搏，同时跟踪3台设备，显示心内心电图。消融后2分钟三维心肌延迟增强可见淋巴结损伤。3头猪中2头房室结阻滞成功，1头暂时性阻滞。结论：在MRI引导下，la定位、PV射频消融和房室结消融均得到证实。术中三维心肌延迟增强评估病变位置准确性和尺寸。（中国心律失常电生理杂志，2009;2:695-704）
Background-The MRI-compatible electrophysiology system previously used for MR-guided left ventricular electroanatomic mapping was enhanced with improved MR tracking, an MR-compatible radiofrequency ablation system and higher-resolution imaging sequences to enable mapping, ablation, and ablation monitoring in smaller cardiac structures. MR-tracked navigation was performed to the left atrium (LA) and atrioventricular (AV) node, followed by LA electroanatomic mapping and radiofrequency ablation of the pulmonary veins (PVs) and AV node.Methods and Results-One ventricular ablation, 7 PV ablations, 3 LA mappings, and 3 AV node ablations were conducted. Three MRI-compatible devices (ablation/mapping catheter, torqueable sheath, stimulation/pacing catheter) were used, each with 4 to 5 tracking microcoils. Transseptal puncture was performed under x-ray, with all other procedural steps performed in the MRI. Preacquired MRI roadmaps served for real-time catheter navigation. Simultaneous tracking of 3 devices was performed at 13 frames per second. LA mapping and PV radiofrequency ablation were performed using tracked ablation catheters and sheaths. Ablation points were registered and verified after ablation using 3D myocardial delayed enhancement and postmortem gross tissue examination. Complete LA electroanatomic mapping was achieved in 3 of 3 pigs, Right inferior PV circumferential ablation was achieved in 3 of 7 pigs, with incomplete isolation caused by limited catheter deflection. During AV node ablation, ventricular pacing was performed, 3 devices were simultaneously tracked, and intracardiac ECGs were displayed. 3D myocardial delayed enhancement visualized node injury 2 minutes after ablation. AV node block succeeded in 2 of 3 pigs, with 1 temporary block.Conclusions-LA mapping, PV radiofrequency ablation, and AV node ablation were demonstrated under MRI guidance. Intraprocedural 3D myocardial delayed enhancement assessed lesion positional accuracy and dimensions. (Circ Arrhythm Electrophysiol. 2009; 2: 695-704.)