3-Dimensional Transseptal Puncture Based on Electrographic Characteristics of Fossa Ovalis A Fluoroscopy -Free and Echocardiography -Free Method
3-Dimensional Transseptal Puncture Based on Electrographic Characteristics of Fossa Ovalis A Fluoroscopy -Free and Echocardiography -Free Method
复制标题
基于卵圆窝电图特征的三维房间隔穿刺无需透视和超声心动图的方法
DOI：
10.1016/j.jcin.2020.03.015
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发表时间：
2020-05-25
影响因子：
11.3
通讯作者：
Ma, Changsheng
中科院分区：
文献类型：
--
作者：
Yu, Ronghui;Liu, Nian;Ma, Changsheng
结论本研究旨在确定卵圆窝（FO）的电图特征，并利用这些发现开发不依赖于荧光透视或超声心动图的三维（3D）经房间隔穿刺（TSP）技术。背景基于荧光透视或超声心动图的传统TSP方法基本上是二维（2D）技术。一个有效的三维TSP的方法还没有得到充分的澄清。方法通过比较FO的电位特征与周围利姆布斯的电位特征，“电描记”确定FO的形状及其中心。经心内超声心动图验证后，该FO标测被纳入右心房的3D电解剖重建中。使用新的导管连接，房间隔穿刺针可以在非透视下可视化，并在电解剖图上精确定位FO。结果共纳入276例接受房颤消融术的患者。中央FO被确定在所有情况下，心房电图电压在0.33 - 0.21 mV。FO环处心房电位振幅为1.70 ± 0.72mV（P < 0.001）。通过将电图定义的FO纳入3D电解剖标测并使用经中隔针可视化方法，所有患者的TSP均成功，91%的病例在首次尝试时成功。所有患者均完成房颤消融，无严重并发症。结论：FO中心区的电图特征与周围区域不同。该信息可用于在3D电解剖标测上定义FO，从而促进安全TSP，而无需使用荧光透视或超声心动图进行辅助成像。
OBJECTIVES This study sought to define electrographic characteristics of the fossa ovalis (FO) and use these findings in developing a 3-dimensional (3D) transseptal puncture (TSP) technique that does not rely on fluoroscopy or echocardiography. BACKGROUND Traditional TSP method based on fluoroscopy or echocardiography is basically a 2-dimensional (2D) technique. A valid 3D method of TSP has not been sufficiently clarified. METHODS The shape of the FO and its center were "electrographically" defined by comparing their potential characteristics to those of the surrounding limbus. After validation by intracardiac echocardiography, this FO mapping was incorporated into 3D electroanatomical reconstruction of the right atrium. Using a new catheter connection, the transseptal needle could be visualized nonfluoroscopically and directed to the precise localization of the FO on the electroanatomic map. RESULTS A total of 276 patients who underwent atrial fibrillation ablation were included. The central FO was identified in all cases with atrial electrogram voltage at 0.33 0.21 mV. The amplitude of atrial potential at the FO annulus was 1.70 0.72 mV (p < 0.001). By incorporating the electrographically defined FO into the 3D electroanatomic mapping and using the transseptal needle visualization approach, TSP was successful in all patients, with 91% of the cases at the first attempt. Atrial fibrillation ablation was completed in all patients with no major complication. CONCLUSIONS Electrographic characteristics of the FO center are distinct from those of the surrounding regions. This information can be leveraged to define the FO on 3D electroanatomic mappings, thereby facilitating safe TSP without the need of ancillary imaging with fluoroscopy or echocardiography.