Percutaneous intrapericardial echocardiography during catheter ablation:: a feasibility study
Percutaneous intrapericardial echocardiography during catheter ablation:: a feasibility study
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DOI：
10.1016/j.hrthm.2006.07.025
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发表时间：
2006-11-01
期刊：
影响因子：
5.5
通讯作者：
Shivkumar, Kalyanam
中科院分区：
文献类型：
--
作者：
Horowitz, Barbara Natterson;Vaseghi, Marmar;Shivkumar, Kalyanam
背景：经皮心包通路、心外膜标测和消融已成功应用于导管消融手术。目的：本研究的目的是评估胸部直接心外膜超声成像辅助心导管消融手术的安全性和可行性。方法采用心内超声导管对10例经皮心外膜导管消融患者进行闭胸心外膜显像。所有患者均行心内超声心动图和术前经食管超声心动图检查。使用双丝技术，在心包内放置两个鞘，并在心包窦内操作相控阵超声导管进行成像。结果获得多幅不同角度的图像，便于导管导航。值得注意的是，图像稳定性非常好，左心耳等结构清晰可见。在心包内使用超声导管未发生任何并发症，也未观察到由于在心包间隙中存在额外的导管而限制运动。5例患者的壁运动与电压图相关，显示疤痕区域与壁运动异常相关。正常壁运动评分与感知信号4.2 +/- 0.3 mV（正常心肌>1.5 mV）相关，>评分与有信号区域相关
BACKGROUND Percutaneous pericardial access, epicardial mapping, and ablation have been used successfully for catheter ablation procedures.OBJECTIVES The purpose of this study was to evaluate the safety and feasibility of dosed-chest direct epicardial ultrasound imaging for aiding cardiac catheter ablation procedures.METHODS An intracardiac ultrasound catheter was used for closed-chest epicardial imaging of the heart in 10 patients undergoing percutaneous epicardial access for catheter ablation. ALL patients underwent concomitant intracardiac echocardiography and preprocedural transesophageal echocardiography. Using a double-wire technique, two sheaths were placed in the pericardium, and a phased-array ultrasound catheter was manipulated within the pericardial sinuses for imaging.RESULTS Multiple images from varying angles were obtained for catheter navigation. Notably, image stability was excellent, and structures such as the Left atrial appendage were seen in great detail. No complications resulting from use of the ultrasound catheter in the pericardium occurred, and no restriction of movement due to the presence of the additional catheter in the pericardial space was observed. Wall motion was correlated to voltage maps in five patients and showed that areas of scars correlated with wall-motion abnormalities. Normal wall-motion score correlated to sensed signals of 4.2 +/- 0.3 mV (normal myocardium >1.5 mV), and scores >1 correlated to areas with signals