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
We report the case of a 14-year-old boy with ventricular preexcitation. A standard, fluoroscopy guided, ablation procedure was successfully performed in a postero-midseptal region with a total fluoroscopy time of abou...We report the case of a 14-year-old boy with ventricular preexcitation. A standard, fluoroscopy guided, ablation procedure was successfully performed in a postero-midseptal region with a total fluoroscopy time of about 45 min (2430 cGy.cm2). A few hours after the procedure, preexcitation reappeared. A second ablation procedure was scheduled using the EnSite NavXTM mapping system. During mapping along the tricuspid groove, preexcitation suddenly disappeared due to mechanical "bumping" of the accessory pathway and it did not recover over the next 30 min. As per our routine practice, the phase of geometry reconstruction has been continuously recorded by the system; thus, an off-line analysis allowed to pinpoint the site of earliest activation and the site of mechanical bumping, where radiofrequency obtained the accessory pathway ablation. The second procedure was performed without using fluoroscopy at all. Thanks to the geometry reconstruction, the procedure was completely successful thus avoiding a further rehospitalization.展开更多
目的探讨不同节律下心房颤动(简称房颤)患者电解剖标测心房低电压区(low voltage areas,LVAs)的特征及意义,并分析单纯肺静脉隔离(pulmonary vein isolation,PVI)术对LVAs的影响。方法连续纳入首次接受射频消融治疗的84例房颤患者,其中4...目的探讨不同节律下心房颤动(简称房颤)患者电解剖标测心房低电压区(low voltage areas,LVAs)的特征及意义,并分析单纯肺静脉隔离(pulmonary vein isolation,PVI)术对LVAs的影响。方法连续纳入首次接受射频消融治疗的84例房颤患者,其中49例阵发性房颤,35例持续性房颤,使用倾向性评分进行匹配。在0.5 mV的阈值下测量心房五分区后各区域LVAs的面积并进行分析。结果根据年龄、性别、BMI,采用倾向性评分匹配出31组患者。阵发性房颤患者术前平均标测点数为(1434.2±393.6)个,术后为(1281.3±372.7)个;持续性房颤患者术前平均标测点数为(1652.6±728.2)个,术后为(1314.6±690.8)个。在所有研究对象中,均可记录到LVAs的存在。阵发性房颤患者术前术后LVAs面积比较,差异无统计学意义;持续性房颤患者LVAs面积术后明显下降(P<0.05)。在所有84例房颤患者中,LVAs出现在前壁、间隔、下壁、侧壁和后壁的比例分别为69.0%、95.2%、82.1%、60.7%和52.4%。结论在相同的电压阈值下,持续性房颤患者LVAs面积在房颤节律下明显大于窦性节律下,单纯PVI术对LVAs影响不大。房颤患者中LVAs好发于前壁、间隔及下壁。展开更多
Background Linear ablation of left atrium （LA） guided by three dimensional （3-D） electroanatomical mapping （Carto） has been used in many centres worldwide for the treatment of atrial fibrillation （AF） instead ...Background Linear ablation of left atrium （LA） guided by three dimensional （3-D） electroanatomical mapping （Carto） has been used in many centres worldwide for the treatment of atrial fibrillation （AF） instead of pure anatomical approaches. There were little data about linear ablation of LA guided by Carto and double Lasso catheters in China. We report the results of linear ablation of LA guided by both Carto and double Lasso catheters. Methods After the anatomical model of LA and all pulmonary veins （PVs） had been established, circumferential ablations of the left pulmonary vein antrum and the right pulmonary vein antrum were performed with 2 circumferential mapping catheters （Lasso） placed within the ipsilateral superior and inferior PVs. The endpoint of ablation was abolishment or dissociation of the pulmonary vein potentials （PVPs）. Oral amiodarone or propafenone was taken for at least 3 months by patients with persistent AF, permanent AF or those whose PVPs had not been isolated completely. The recurrence of atrial tachyarrhythmias was observed 3 months after the procedure. Results There were 106 patients （mean age, 51.4±9.9 years）. Seventy-eight patients had paroxysmal AF, 12 persistent AF and 16 permanent AF. Onset of atrial fibrillation occurred in 52 patients during ablation procedure. Thirty-two patients restored to sinus rhythm eventually after the procedure. Abolishment or dissociation of PVPs was accomplished during the procedure in 94 patients （88.7%）. The duration of procedure and exposure to X-ray were （213±45） minutes and （32.5± 12.8） minutes, respectively. Among the 87 patients followed up for over 3 months, 62 were free of atrial tachyarrhythmias （including 8 patients who were still taking oral amiodarone）. The success rate was 71.3% in the first procedure. Two patients had pericardial effusion treated by pericardial puncture and effusion drainage. No pulmonary vein stenosis, atrioesophageal fistula, stroke or procedural death occurred. Conclusi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We report the case of a 14-year-old boy with ventricular preexcitation. A standard, fluoroscopy guided, ablation procedure was successfully performed in a postero-midseptal region with a total fluoroscopy time of about 45 min (2430 cGy.cm2). A few hours after the procedure, preexcitation reappeared. A second ablation procedure was scheduled using the EnSite NavXTM mapping system. During mapping along the tricuspid groove, preexcitation suddenly disappeared due to mechanical "bumping" of the accessory pathway and it did not recover over the next 30 min. As per our routine practice, the phase of geometry reconstruction has been continuously recorded by the system; thus, an off-line analysis allowed to pinpoint the site of earliest activation and the site of mechanical bumping, where radiofrequency obtained the accessory pathway ablation. The second procedure was performed without using fluoroscopy at all. Thanks to the geometry reconstruction, the procedure was completely successful thus avoiding a further rehospitalization.
文摘Background Linear ablation of left atrium （LA） guided by three dimensional （3-D） electroanatomical mapping （Carto） has been used in many centres worldwide for the treatment of atrial fibrillation （AF） instead of pure anatomical approaches. There were little data about linear ablation of LA guided by Carto and double Lasso catheters in China. We report the results of linear ablation of LA guided by both Carto and double Lasso catheters. Methods After the anatomical model of LA and all pulmonary veins （PVs） had been established, circumferential ablations of the left pulmonary vein antrum and the right pulmonary vein antrum were performed with 2 circumferential mapping catheters （Lasso） placed within the ipsilateral superior and inferior PVs. The endpoint of ablation was abolishment or dissociation of the pulmonary vein potentials （PVPs）. Oral amiodarone or propafenone was taken for at least 3 months by patients with persistent AF, permanent AF or those whose PVPs had not been isolated completely. The recurrence of atrial tachyarrhythmias was observed 3 months after the procedure. Results There were 106 patients （mean age, 51.4±9.9 years）. Seventy-eight patients had paroxysmal AF, 12 persistent AF and 16 permanent AF. Onset of atrial fibrillation occurred in 52 patients during ablation procedure. Thirty-two patients restored to sinus rhythm eventually after the procedure. Abolishment or dissociation of PVPs was accomplished during the procedure in 94 patients （88.7%）. The duration of procedure and exposure to X-ray were （213±45） minutes and （32.5± 12.8） minutes, respectively. Among the 87 patients followed up for over 3 months, 62 were free of atrial tachyarrhythmias （including 8 patients who were still taking oral amiodarone）. The success rate was 71.3% in the first procedure. Two patients had pericardial effusion treated by pericardial puncture and effusion drainage. No pulmonary vein stenosis, atrioesophageal fistula, stroke or procedural death occurred. Conclusi
