Characteristics in image integration system guiding catheter ablation of atrial fibrillation with a common ostium of inferior pulmonary veins
Characteristics in image integration system guiding catheter ablation of atrial fibrillation with a common ostium of inferior pulmonary veins
复制标题
图像集成系统引导下肺静脉共同口心房颤动导管消融的特点
DOI：
10.1111/j.1540-8159.2007.00931.x
复制
发表时间：
2008-01-01
影响因子：
1.8
通讯作者：
Ma, Changsheng
中科院分区：
文献类型：
--
作者：
Yu, Ronghui;Dong, Jianzeng;Ma, Changsheng
背景：下肺静脉共口（pv）是肺静脉引流至左心房（LA）的一种异常变异，其解剖、电生理及导管消融特征很少被证实，且该异常患者的导管消融治疗心房颤动（AF）的连续系列研究尚未见报道。方法：1226例药物难治性房颤患者在消融前接受磁共振血管造影（MRA）或多层计算机断层扫描（MDCT）扫描。采用电生理定位检测阵发性房颤的病灶触发点。导管消融的基本策略是在图像集成系统的引导下，采用“三圆”环形隔离PV：两个圆围绕两个上PV，另一个围绕主干。结果：11例（0.9%）患者消融前经图像整合系统重建的左、右下静脉有共同的肺静脉口。这种异常可分为两种类型：A型无短共同主干的劣质pv和B型短共同主干。57%的阵发性房颤是在共口引起的。这种策略的成功率为90%。结论：下pv共口根据有无短共干可分为两种类型。在阵发性声发射中，共口通常是一个重要的触发病灶。在图像集成系统的指导下，采用“三环”围周PV隔离消融策略是一个不错的选择。
Background: Common ostium of the inferior pulmonary veins (PVs) is a kind of unusual variation in pulmonary venous drainage to the left atrium (LA), whose feature of anatomy, electrophysiology, and catheter ablation is rarely demonstrated, and the consecutive series of research for catheter ablation of atrial fibrillation (AF) in patients with that anomaly have not been reported.Methods: A total of 1,226 patients with drug-refractory AF received magnetic resonance angiography (MRA) or multidetector computed tomography (MDCT) scan before ablation. Electrophysiological mapping was used to detect the focal triggers in paroxysmal AF. Basic catheter ablation strategy was circumferential PV isolation with "tricircle" under the guidance of image integration system: two circles surround two superior PVs, and the other surround the common trunk.Results: LA and PVs reconstruction by image integration system showed a common pulmonary venous ostium of the right and left inferior PVs before ablation in 11 patients (0.9%). This anomaly could be classified into two types: type A without a short common trunk of inferior PVs and type B with a short common trunk. Fifty-seven percent paroxysmal AF was revealed focal triggers in the common ostium. The success rate of that strategy was 90%.Conclusion: Common ostium of inferior PVs could be classified into two types according to the presence of a short common trunk or not. The common ostium was usually an important triggering focus in paroxysmal AE Catheter ablation strategy of circumferential PV isolation with "tricircle" under the guidance of image integration system would be a good choice.