Background CartoXP and CartoMerge have been used to treat atrial fibrillation （AF） for several years. Our randomized prospective study compared clinical outcomes of these two versions of three dimensional electroana...Background CartoXP and CartoMerge have been used to treat atrial fibrillation （AF） for several years. Our randomized prospective study compared clinical outcomes of these two versions of three dimensional electroanatomic mapping system in guiding catheter ablation for paroxysmal atrial fibrillation （PAF）. Methods Eighty-one patients with symptomatic, drug refractory PAF were randomly assigned to CartoMerge group （n=-42, mean age （54.5 ＋ 13.1） years, history of AF = 3.2 years） or CartoXP group （n=39, mean age （59.8 ± 15.6） years, history of AF = 2.9 years）. All patients underwent 64-slice computed tomography （MSCT） 1 to 3 days prior to ablation procedure. Using CartoMergeTM Image Integration Module, 3D anatomical images of the left atrium （LA） and pulmonary veins （PVS） derived from MSCT of CartoMerge group were established and merged with the electroanatomical map. The integrated images were used to guide the procedure of circumferential pulmonary vein isolation （CPVl）. In the other group, CPVl was guided just by CartoXP. The endpoint of CPVl in both groups was abolition or dissociation of pulmonary vein potentials （PVPs）. Results Mapping points to establish the electroanatomical model of the LA/PVs were 48.7＋13.4 in CartoMerge group and 62.5±15.7 in CartoXP group （P〈0.001）. Mean distance between mapping points and the MSCT surfaces in CartoMerge group was （1.59±0.33） mm. Accomplishment of abolition or dissociation of PVPs was achieved 95.2% in CartoMerge group and 92.3% in CartoXP group. Durations of procedure and exposure to X-ray were （156±25） minutes, （179±21） minutes （P〈0.001） and （19.6±7.5） minutes, （28.5±12.8） minutes （P 〈0.001）, respectively. After a follow-up with duration of （11.9＋3.1） months vs （12.4±3.6） months post the first ablation procedure, patients free of AF were 33 （78.6%） in CartoMerge group and 29 （74.4%） in CartoXP group （P〉0.50）. No patient suffered pulmonary vein stenosis, 展开更多
目的比较环肺静脉电隔离术(CPVI)与环肺静脉电隔离联合复杂碎裂电位(CPVI+CFAEs)消融术治疗阵发性心房颤动(简称房颤)及持续性房颤疗效的长期随访结果。方法 209例房颤患者随机分为CPVI组(n=103)和CPVI+CFAEs消融组(n=106),其中阵发性房...目的比较环肺静脉电隔离术(CPVI)与环肺静脉电隔离联合复杂碎裂电位(CPVI+CFAEs)消融术治疗阵发性心房颤动(简称房颤)及持续性房颤疗效的长期随访结果。方法 209例房颤患者随机分为CPVI组(n=103)和CPVI+CFAEs消融组(n=106),其中阵发性房颤123例,持续性房颤86例。消融术后进行不少于36个月的定期随访,随访内容包括并发症及是否维持窦性心律等。结果 CPVI+CFAEs消融组较CPVI组消融时间、透视时间明显延长(124.3±30.9 min vs 140.3±36 min,35.4±9.1 min vs 43±11 min,P均<0.05),肺静脉隔离时间两组无差别。所有患者至少随访36个月,阵发性房颤患者两组窦性心律维持率无差异,持续性房颤患者CPVI+CFAEs消融组较CP-VI消融组6,12个月的成功率(维持窦性心律)高(73.2%vs 51.1%,65.9%vs 44.4%)。两组患者随访期间并发症发生无差别。结论 CPVI+CFAEs消融较CPVI消融治疗阵发性房颤的成功率相似,但消融时间和透视时间明显延长;持续性房颤CPVI+CFAEs消融组12个月内维持窦性心律比例高,超过12个月的长期随访这种差异不再显著。展开更多
目的比较肺静脉节段性隔离(SPVI)与EnSite Nav X三维电生理系统指导下环肺静脉隔离导管消融(CPVA)治疗心房颤动的有效性与安全性。方法入选共85例房颤患者,单纯肺静脉环状电极指导下行肺静脉节段性隔离40例(阵发性30例,持续性10例);EnSi...目的比较肺静脉节段性隔离(SPVI)与EnSite Nav X三维电生理系统指导下环肺静脉隔离导管消融(CPVA)治疗心房颤动的有效性与安全性。方法入选共85例房颤患者,单纯肺静脉环状电极指导下行肺静脉节段性隔离40例(阵发性30例,持续性10例);EnSite Nav X三维电生理系统指导下环肺静脉隔离45例(阵发性31例,持续性14例),随访均超过半年。结果SPVI组成功率为65%,CPVA组成功率为84.4%,P=0.038。主要并发症发生率SPVI组为17.5%,CPVA组为6.7%,P=0.0845;肺静脉狭窄率在CPVA组为0%,在SPVI组为12.5%,P=0.0312。总手术操作时间在SPVI组为(200.4±37.0)min,在CPVA组为(226.5±26.1)min,P=0.002。X线曝光时间在SPVI组为(54.7±9.7)min,在CPVA组为(27.1±3.1)min,P<0.0001。结论EnSite Nav X三维电生理系统指导下环肺静脉隔离导管消融治疗房颤较单纯肺静脉环状电极指导下的节段性肺静脉隔离更为有效且X线曝光时间更短,但手术操作时间较长;主要并发症发生率在两组间无明显差异,但环肺静脉隔离组的肺静脉狭窄率较节段性隔离组低。展开更多
Background CartoMerge has been widely used in guiding circumferential pulmonary vein isolation （CPVI） for the treatment of paroxysmal atrial fibrillation （PAF）. However, the procedure of landmarks selection varies...Background CartoMerge has been widely used in guiding circumferential pulmonary vein isolation （CPVI） for the treatment of paroxysmal atrial fibrillation （PAF）. However, the procedure of landmarks selection varies among operators according to their experience. Techniques have to be established to standardize this procedure. We propose that Overlay Ref could facilitate this procedure. This paper aimed to report our initial experience with CPVI guided by Overlay Ref and CartoMerge for the treatment of PAF. Methods Fifty-nine patients with PAF were enrolled in this study. Using Overlay Ref technique, a reference image （inverted） was faded into the live fluoroscopic image. Landmarks of CartoMerge were selected from anatomic points of the top of superior pulmonary veins （PVs） and the bottom of inferior PVs guided by Overlay Ref image. Overlay Ref images were also used to guide the ablation procedure combining with CartoMerge. Results All patients were successfully mapped by CartoMerge guided by Overlay Ref. The distance between the mapping points and the CT surfaces was （1.42±0.67） mm for the patients as a whole. This led to a successful rate of 96% for isolation of pulmonary veins. Duration of ablation procedure was （92±17） minutes. And the total duration of procedure was （139±32） minutes. CartoMerge could also be performed just with 3 paries to 4 paries selected landmarks guided by Overlay Ref without a full anatomic model constructed by Carto. Then, the total duration of procedure could be shortened to （115±38） minutes. Conclusions Overlay Ref technique can facilitate the catheter ablation of PAF and can help to standardize the procedure of landmarks selection.展开更多
文摘Background CartoXP and CartoMerge have been used to treat atrial fibrillation （AF） for several years. Our randomized prospective study compared clinical outcomes of these two versions of three dimensional electroanatomic mapping system in guiding catheter ablation for paroxysmal atrial fibrillation （PAF）. Methods Eighty-one patients with symptomatic, drug refractory PAF were randomly assigned to CartoMerge group （n=-42, mean age （54.5 ＋ 13.1） years, history of AF = 3.2 years） or CartoXP group （n=39, mean age （59.8 ± 15.6） years, history of AF = 2.9 years）. All patients underwent 64-slice computed tomography （MSCT） 1 to 3 days prior to ablation procedure. Using CartoMergeTM Image Integration Module, 3D anatomical images of the left atrium （LA） and pulmonary veins （PVS） derived from MSCT of CartoMerge group were established and merged with the electroanatomical map. The integrated images were used to guide the procedure of circumferential pulmonary vein isolation （CPVl）. In the other group, CPVl was guided just by CartoXP. The endpoint of CPVl in both groups was abolition or dissociation of pulmonary vein potentials （PVPs）. Results Mapping points to establish the electroanatomical model of the LA/PVs were 48.7＋13.4 in CartoMerge group and 62.5±15.7 in CartoXP group （P〈0.001）. Mean distance between mapping points and the MSCT surfaces in CartoMerge group was （1.59±0.33） mm. Accomplishment of abolition or dissociation of PVPs was achieved 95.2% in CartoMerge group and 92.3% in CartoXP group. Durations of procedure and exposure to X-ray were （156±25） minutes, （179±21） minutes （P〈0.001） and （19.6±7.5） minutes, （28.5±12.8） minutes （P 〈0.001）, respectively. After a follow-up with duration of （11.9＋3.1） months vs （12.4±3.6） months post the first ablation procedure, patients free of AF were 33 （78.6%） in CartoMerge group and 29 （74.4%） in CartoXP group （P〉0.50）. No patient suffered pulmonary vein stenosis,
文摘目的比较环肺静脉电隔离术(CPVI)与环肺静脉电隔离联合复杂碎裂电位(CPVI+CFAEs)消融术治疗阵发性心房颤动(简称房颤)及持续性房颤疗效的长期随访结果。方法 209例房颤患者随机分为CPVI组(n=103)和CPVI+CFAEs消融组(n=106),其中阵发性房颤123例,持续性房颤86例。消融术后进行不少于36个月的定期随访,随访内容包括并发症及是否维持窦性心律等。结果 CPVI+CFAEs消融组较CPVI组消融时间、透视时间明显延长(124.3±30.9 min vs 140.3±36 min,35.4±9.1 min vs 43±11 min,P均<0.05),肺静脉隔离时间两组无差别。所有患者至少随访36个月,阵发性房颤患者两组窦性心律维持率无差异,持续性房颤患者CPVI+CFAEs消融组较CP-VI消融组6,12个月的成功率(维持窦性心律)高(73.2%vs 51.1%,65.9%vs 44.4%)。两组患者随访期间并发症发生无差别。结论 CPVI+CFAEs消融较CPVI消融治疗阵发性房颤的成功率相似,但消融时间和透视时间明显延长;持续性房颤CPVI+CFAEs消融组12个月内维持窦性心律比例高,超过12个月的长期随访这种差异不再显著。
文摘目的比较肺静脉节段性隔离(SPVI)与EnSite Nav X三维电生理系统指导下环肺静脉隔离导管消融(CPVA)治疗心房颤动的有效性与安全性。方法入选共85例房颤患者,单纯肺静脉环状电极指导下行肺静脉节段性隔离40例(阵发性30例,持续性10例);EnSite Nav X三维电生理系统指导下环肺静脉隔离45例(阵发性31例,持续性14例),随访均超过半年。结果SPVI组成功率为65%,CPVA组成功率为84.4%,P=0.038。主要并发症发生率SPVI组为17.5%,CPVA组为6.7%,P=0.0845;肺静脉狭窄率在CPVA组为0%,在SPVI组为12.5%,P=0.0312。总手术操作时间在SPVI组为(200.4±37.0)min,在CPVA组为(226.5±26.1)min,P=0.002。X线曝光时间在SPVI组为(54.7±9.7)min,在CPVA组为(27.1±3.1)min,P<0.0001。结论EnSite Nav X三维电生理系统指导下环肺静脉隔离导管消融治疗房颤较单纯肺静脉环状电极指导下的节段性肺静脉隔离更为有效且X线曝光时间更短,但手术操作时间较长;主要并发症发生率在两组间无明显差异,但环肺静脉隔离组的肺静脉狭窄率较节段性隔离组低。
文摘Background CartoMerge has been widely used in guiding circumferential pulmonary vein isolation （CPVI） for the treatment of paroxysmal atrial fibrillation （PAF）. However, the procedure of landmarks selection varies among operators according to their experience. Techniques have to be established to standardize this procedure. We propose that Overlay Ref could facilitate this procedure. This paper aimed to report our initial experience with CPVI guided by Overlay Ref and CartoMerge for the treatment of PAF. Methods Fifty-nine patients with PAF were enrolled in this study. Using Overlay Ref technique, a reference image （inverted） was faded into the live fluoroscopic image. Landmarks of CartoMerge were selected from anatomic points of the top of superior pulmonary veins （PVs） and the bottom of inferior PVs guided by Overlay Ref image. Overlay Ref images were also used to guide the ablation procedure combining with CartoMerge. Results All patients were successfully mapped by CartoMerge guided by Overlay Ref. The distance between the mapping points and the CT surfaces was （1.42±0.67） mm for the patients as a whole. This led to a successful rate of 96% for isolation of pulmonary veins. Duration of ablation procedure was （92±17） minutes. And the total duration of procedure was （139±32） minutes. CartoMerge could also be performed just with 3 paries to 4 paries selected landmarks guided by Overlay Ref without a full anatomic model constructed by Carto. Then, the total duration of procedure could be shortened to （115±38） minutes. Conclusions Overlay Ref technique can facilitate the catheter ablation of PAF and can help to standardize the procedure of landmarks selection.
