Catheter motion during atrial ablation due to the beating heart and respiration: Impact on accuracy and spatial referencing in three-dimensional mapping
Catheter motion during atrial ablation due to the beating heart and respiration: Impact on accuracy and spatial referencing in three-dimensional mapping
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DOI：
10.1016/j.hrthm.2007.01.016
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发表时间：
2007-05-01
期刊：
影响因子：
5.5
通讯作者：
Willems, Stephan
中科院分区：
文献类型：
--
作者：
Klemm, Hanno U.;Steven, Daniel;Willems, Stephan
心脏三维标测系统的准确性受心脏收缩和呼吸的影响。目的本研究旨在确定心脏和胸部结构的相对运动，以评估位置误差并指导最佳空间参考的选择。方法将导管放置在冠状窦（CS），肺静脉（PV）口，左心房（LA）峡部和顶部，三尖瓣环峡部（CTI），使用Ensite-NavX记录了30例患者的右心耳（RAA）。包括右锁骨下静脉、左头臂静脉、奇静脉、肺动脉和静态参考。计算每对部位相对于平均位置的位移。结果肺静脉对间位移平均为4.1 ± 0.2 mm，对间位移平均为5.0 ± 0.5 mm。所有左心房结构的近端CS参考（4.0 ± 1.1 mm）上级静态参考（4.9 ± 0.7 mm; P = 0.01）。此外，呼吸引起的偏移不太明显，分别为3.5 ± 0.8 mm和4.9 ± 0.5 mm（P = 0.004）。心外血管运动受平均移位6.8 ± 1 mm的影响。远端锁骨下静脉和头臂静脉受影响程度（7.6 ± 0.7 mm）大于肺动脉（5.9 ± 0.4 mm; P = 0.002）。对于三尖瓣环峡部，一个最小的平均位移小于4.6 +/- 2.0 mm相对于近端CS，RAA，和奇静脉被发现。结论呼吸是相对运动的主要来源，这增加了与心脏的距离。对于LA手术，近端CS参考位置上级于静态参考位置。
BACKGROUND The accuracy of three-dimensional mapping systems is affected by cardiac contraction and respiration.OBJECTIVE The study sought to determine relative motion of cardiac and thoracic structures to assess positional errors and guide the choice of an optimized spatial reference.METHODS Motion of catheters placed at the coronary sinus (CS), pulmonary vein (PV) ostia, left atrial (LA) isthmus and roof, cavotricuspid isthmus (CTI), and right atrial appendage (RAA) were recorded for 30 patients using Ensite-NavX. The right subclavian vein, left brachiocephalic vein, azygos vein, pulmonary arteries, and a static reference were included. The displacement from a mean position was calculated for each pair of sites. Respiration effects were assessed by the shift of the motion curve during in- and expiration phases.RESULTS The PVs showed a mean interpair displacement of 4.1 +/- 0.2 mm and a shift of 5.0 +/- 0.5 mm. Proximal CS references for all LA structures (4.0 +/- 1.1 mm) were superior to the static reference (4.9 +/- 0.7 mm; P = .01). In addition, the shift due to respiration was Less pronounced at 3.5 +/- 0.8 mm versus 4.9 0.5 mm (P = .004), respectively. Motion of extracardiac vessels was influenced by a mean shift of 6.8 +/- 1 mm. The remote subclavian and brachiocephalic veins were more affected (7.6 +/- 0.7 mm) than the pulmonary arteries (5.9 +/- 0.4 mm; P = .002). For the CTI, a minimized mean displacement of less than 4.6 +/- 2.0 mm relative to the proximal CS, RAA, and azygos vein was found.CONCLUSION Respiration is the major source of relative motion, which increases with distance from the heart. For LA procedures, a proximal CS reference position is superior to a static reference position.