摘要目的 探讨应用新型三维心脏电生理标测系统ColumbusTM消融持续性房颤的效果.方法 顺序入选2012年10月至2013年10月于本院就诊的抗心律失常药物疗效欠佳的持续性房颤患者纳入本研究.所有患者术前口服华法林有效抗凝至少3周,行经食管超声心动图和心脏CT检查排除心腔内血栓,术前停用除胺碘酮以外抗心律失常药物5d以上.应用ColumbusTM三维心脏电生理标测系统取点(≥20个)建立左房和肺静脉三维解剖模型,计算每点与相应CT影像的最近距离,评价左房模型的准确性.所有患者行环肺静脉消融(CPVA)至肺静脉电隔离(PVI),同时行辅助线性消融.记录左房建模时间、PVI时间、手术时间、X线曝光时间.术后随访1年,进行消融治疗的安全性和疗效评价.结果 本研究共入选持续性房颤患者7例.所有患者应用ColumbusTM系统成功建立左房模型,左房容积为(111.1±29.9)ml.ColumbusTM系统左房模型与CT左房模型配准误差为(1.99±0.51)mm.所有患者均完成CPVA、二尖瓣狭部和左房顶部消融,3例患者同时行三尖瓣狭部消融,术中所有患者均实现PVI、消融线双向阻滞.手术时间(185.9±42.1)min,左房建模时间(14.0±4.6)min,PVI时间(96.9±46.3)min,X线曝光时间(27.3±11.2) min.术后随访1年,所有患者未发生手术相关并发症,1例患者房颤复发,6例患者稳定维持窦性心律,且无需抗心律失常药物.结论 应用ColumbusTM三维心脏电生理标测系统可准确建立心房三维解剖模型,指导消融持续性房颤安全有效.

abstractsObjective To investigate the efficiency of ColumbusTM,a new threalimensional cardiac electrophysiological mapping system in the ablation of persistent atrial fibrillation (AF).Methods Consecutive patients with persistent AF uncontrolled on medications in our hospital between October 2012 and October 2013 were included in this study.Before the operation,all patients received oral warfarin for effective anticoagulation for at least 3 weeks,and underwent transesophageal echocardiography and cardiac CT to exclude intracardiac thrombus.The antiarrhythmic agents other than amiodarone were discontinued at least 5 days before the operation.The threedimensional cardiac electrophysiological mapping system Columbus TM was used to create a point cloud (≥20 points) to establish the threedimensional anatomical model of the left atrium and pulmonary veins.The shortest distances between points and their corresponding image on CT were calculated to evaluate the accuracy of the left atrium model.All the patients underwent procedures ranging from circumferential pulmonary vein ablation (CPVA) to pulmonary vein isolation (PVI),and with auxiliary linear ablation.The left atrial modeling time,PVI time,operation time,and Xray exposure time were recorded.The safety and efficacy of the ablation were evaluated during the oneycear follovop after the operation.Results Seven patients with persistent AF were included in this study.The left atrial models were successfully established in all patients by using ColumbusTM system,and the left atrial volume was (111.1 ± 29.9) ml.The registration error between the geometric left atrial model by ColumbusTM system and the CT left atrial model was (1.99±0.51) mm.All the patients underwent CPVA,and the ablation of mitral isthmus and the top of left atrium.Three patients underwent the ablation of tricuspid isthmus at the same time.All patients achieved intraoperative PVI,and bidirectional block of linear ablation.The operation time,left atrial modeling time,PVI time,and Xray exposure time was (185.9±42.1) min,(14.0±4.6) min,(96.9±46.3)min,and (27.3± 11.2) min,respectively.At 1 year of the postoperative follow up,no operationrelated complications was found in all patients.One patient suffered recurrence of AF;the remaining 6 were stable on sinus rhythms without using antiarrhythmic drugs.Conclusion The ColumbusTM threedimensional cardiac electrophysiological mapping system can accurately establish threedimensional anatomical model of the atria,which is safe and effective for guiding the ablation for persistent AF.