CAJ | 학술논문

目的探讨影像融合系统指导下导管消融伴双下肺静脉共同开口的心房颤动(房颤)的解剖学、电生理学和治疗学特点.方法 1381例药物治疗无效的房颤患者在消融前接受磁共振血管造影或多排CT扫描,影像融合技术(CartoMergeTM software)重建左心房和肺静脉.阵发性房颤者进行了触发灶的电生理标测.基本消融策略是在影像融合系统指导下"三环法"肺静脉隔离:两个环分别围绕两个上肺静脉,另一个环围绕双下肺静脉共同开口.结果影像融合系统成功重建1381例左心房和肺静脉并发现有12例(0.8%)为左、右下肺静脉共同开口,这种变异可分为两种形态:没有短共干的Ⅰ型双下肺静脉共同开口和有短共干的Ⅱ型双下肺静脉共同开口.多数阵发性房颤在共同开口内有触发灶."三环法"肺静脉隔离术成功率83%.结论双下肺静脉共同开口可按有无短共干分为两型.共同开口内可能是阵发性房颤的重要病灶.在影像融合技术指导下进行"三环法"肺静脉隔离的消融策略可能是伴该种肺静脉变异的房颤患者较好的治疗方法.
목적 탐토영상융합계통지도하도관소융반쌍하폐정맥공동개구적심방전동(방전)적해부학、전생이학화치료학특점.방법 1381례약물치료무효적방전환자재소융전접수자공진혈관조영혹다배CT소묘,영상융합기술(CartoMergeTM software)중건좌심방화폐정맥.진발성방전자진행료촉발조적전생리표측.기본소융책략시재영상융합계통지도하"삼배법"폐정맥격리:량개배분별위요량개상폐정맥,령일개배위요쌍하폐정맥공동개구.결과 영상융합계통성공중건1381례좌심방화폐정맥병발현유12례(0.8%)위좌、우하폐정맥공동개구,저충변이가분위량충형태:몰유단공간적Ⅰ형쌍하폐정맥공동개구화유단공간적Ⅱ형쌍하폐정맥공동개구.다수진발성방전재공동개구내유촉발조."삼배법"폐정맥격리술성공솔83%.결론 쌍하폐정맥공동개구가안유무단공간분위량형.공동개구내가능시진발성방전적중요병조.재영상융합기술지도하진행"삼배법"폐정맥격리적소융책략가능시반해충폐정맥변이적방전환자교호적치료방법.
Objective To investigate the anatomic, electrophysiological and therapeutic characteristics of catheter ablation of atrial fibrillation (AF) with a common ostium of inferior pulmonary veins (PVs) under the guid-ance of image integration system. Methods A total of 1381 patients with drug-refractory AF received magnetic reso-nance angiography (MRA) or multidetector computed tomography (MDCT) scan and LA and PVs reconstruction by image integration system (CartoMergeTM software)before ablation. Electrophysiological mapping was used to detect the focal triggers in paroxymal AF. Basic catheter ablation strategy was circumferential PV isolation with "triple circles" under the guidance of image integration system: two circles surrounding two superior PVs and the third surrounding the common ostium. Results LA and PVs reconstruction by image integration system showed a common pulmonary venous ostium of the right and left inferior PVs before ablation in 12 patients (0.8%). This anomaly could be classified into two types: typeIwithout a short common mink of inferior PVs and typeⅡ with a short common trunk. Most of paroxymal AF was revealed of focal triggers in the common cerium. The success rate of that strategy was 83%. Conclusion Common nstium of inferior PVs could be classified into two types according to presence of a short couunon trunk or not. The common ostium is an important triggering focus in paroxymal AF. Catheter ablation strategy of circumferential PV isolation with "triple circles" under the guidance of image integration system in patients with that anomaly may be a good choice.