BACKGROUND:A detailed appreciation of left atrial/pulmonary vein (LA/PV) anatomy may be important in improving the safety and success of catheter ablation (CA) for atrial fibrillation (AF). OBJECTIVES:The aim of this nonrandomized study was to determine the impact of computerized tomography (CT) image integration into a 3-dimensional (3D) mapping system on the clinical outcome of patients undergoing CA for AF. METHODS:Ninety-four patients (age: 56 +/- 10 years) with AF (paroxysmal 46, persistent 48) underwent wide encirclement of ipsilateral PV pairs using irrigated radiofrequency ablation with the endpoint of electrical isolation. Ablation was guided by 3D mapping alone (electroanatomic 24, noncontact 23) in 47 (3DM group) patients and by CT image integration (Cartomerge) in 47 (CT group). In persistent AF, a combination of linear ablation and targeted ablation of complex fractionated electrograms was also performed. RESULTS:Successful PV electrical isolation did not differ between the two groups. A significant reduction in fluoroscopy times was demonstrated in the CT group (49 +/- 27 minutes vs 3DM group 62 +/- 26 minutes, P = 0.03). Arrhythmia recurrence was reduced in the CT group (32% vs 51% in the 3DM group, P < 0.01). In 30 symptomatic patients (12 CT and 18 3DM), repeat procedures for AF (13 in 3DM and 5 CT, P < or = 0.10) and AT (5 in 3DM and 7 CT, P = NS) were performed. Overall success on 7-day monitor off antiarrhythmic drugs was achieved in 60% in the 3DM group when compared with 83% in the CT group (P < 0.05) at a follow-up of 25 +/- 5 weeks. CONCLUSION:CA for AF guided by CT integration was associated with reduced fluoroscopy times, arrhythmia recurrence, and increased restoration of sinus rhythm. Improved visualization of complex LA geometries might improve the safety and success of CA for AF.

译文

背景:详细了解左心房/肺静脉(LA / PV)解剖结构对于提高房颤(AF)导管消融(CA)的安全性和成功率可能很重要。
目的:这项非随机研究的目的是确定将计算机断层扫描(CT)图像集成到3维(3D)制图系统中对接受CA房颤的患者的临床结局的影响。
方法:94例房颤(阵发性46例,持续性48例)(年龄56 /-10岁)采用射频消融冲洗并以电隔离为终点,对同侧PV对进行了大包围。 47例(3DM组)患者仅通过3D映射(电解剖学24,非接触式23)进行消融,47例(CT组)通过CT图像积分(Cartomerge)进行消融。在持续性房颤中,还执行了复杂的电描记图的线性消融和靶向消融的组合。
结果:两组之间成功的PV电气隔离没有差异。在CT组中,荧光检查时间显着减少(49 /-27分钟,而3DM组62 /-26分钟,P = 0.03)。 CT组心律失常复发率降低(3DM组为32%,而51%为P <0.01)。在30例有症状的患者中(12 CT和18 3DM),重复进行AF(3DM和5 CT中13例,P <或= 0.10)和AT(3DM和7 CT中5例,P = NS)的重复手术。在25 /-5周的随访中,3DM组60%的抗心律失常药物获得了总体成功,而CT组为83%(P <0.05)。
结论:CT整合引导的房颤CA与减少的透视时间,心律失常的复发和窦性心律的恢复增加有关。改善复杂的LA几何图形的可视化可能会提高CA用于AF的安全性和成功性。

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