| BackgroundCatheter ablation was an effective treatment for patients with paroxysmal atrial fibrillation.Varies left atrial and pulmonary vein 3-D image reconstruction methods were developed to localize pulmonary vein antrum to facilitate pulmonary vein isolation(PVI).Three dimensional rotational angiography(3DRA)reconstruct left atrial pulmonary vein model and integrate it into real-time X-ray fluoroscopy system can guide circumferential pulmonary vein antrumradiofrequency ablation.On the other hand,CARTO system with own mapping software to reconstruct the left atrium and pulmonary vein model which can guide the atrial fibrillation ablation.The value of those imaging techniques in guiding radiofrequency ablation of atrial fibrillation needs further comparative analysis to evaluate its safety and effectiveness.ObjectiveTo compare and analysis the efficacy and safety of left atrial and pulmonary vein 3-D image reconstruction methods in guiding catheter ablation of paroxysmal atrial fibrillation.Methods:It was divided into two parts.1~stt Part:A total of 135 patients with drug-refractory paroxysmal atrial fibrillation from January 2014 to January 2017 were selected and included in group A(indirect angiography group),group B(left atrium direct angiography group),and group C(CT fusion group).CARTO3 system was used to mapping and ablation.Group A(50 patients):Contrast agent was injected through the right ventricle,delayed rotational angiography was conducted to construct the model of left atrium and pulmonary vein in order to localize pulmonary vein antrum.Group B(50 patients):Contrast was injected directly into the left atrium through atrial septum puncture,and meanwhile rotational angiography was performed for reconstruction the 3D images of left atrium and pulmonary vein,which was then imported into real-time X-ray scan system to facilitate the isolation of circumferential pulmonary vein ablation.Group C(35 patients):Preoperative Force CT was used to reconstruct left atrial and pulmonary vein.The 3-D images were integrated into real-time X-ray system to facilitate catheter movement and localize pulmonary vein antrum during the procedure.The acquisition time of the left atrial pulmonary vein stereo images,operative procedures,X-ray exposure time,consumption of contrast agent,operative successful rate and incidences of complications for the three groups of patients were observed and recorded.2~ndd Part:150 patients with drug-refractory paroxysmal atrial fibrillation from June 6,2014-June 6,2016 who received radiofrequency ablation of paroxysmal atrial fibrillation were divided into 3 groups.Group A(n=50):Routine point-to-point mapping(PPM)was performed to construct left atrium pulmonary model and guide circumferential pulmonary vein isolation;Group B(n=50):The left atrium and pulmonary vein models were constructed by rapid anatomical mapping(FAM)to localize pulmonary vein antrum and guide circumferential pulmonary vein isolation.Group C(n=50):PPM was used to construct the general model of left atrial rapidly.After the preliminary determination of the pulmonary veins antrum was completed,circumferential pulmonary vein vestibules were constructed using the FAM method.After the accuracy of the pulmonary vein vestibules determination was confirmed,radiofrequency ablation of atrial fibrillation was then performed.The remaining procedures and methods for the three groups of patients were identical.Operation time,X-ray exposure time,successful rate and incidence of complications were recorded in the three groups.Preoperative and postoperative left atrial size and left ventricular ejection fraction(LVEF)were measured by echocardiography.Results:1~stt Part:Catheter ablation was performed in all thoes patients with atrial fibrillation.Operation time,time of X-ray exposure and consumption of contrast agent in group C were significantly lower than those in group A and B(p<0.01).Operation time and time of X-ray exposure of group B were lower than those of group A(p<0.05).The immediate and recent success rates in group C were slightly higher than those in group A and B,but there was no significant difference among the three groups(p>0.05),and there were no significant statistical differences in the incidences of complications among the three groups(p>0.05).2~ndd Part:All of the patients with atrial fibrillation accepted circumferential pulmonary vein ablation.For these three groups of patients,operation time and X-ray exposure time in group C were significantly lower than those in group A and B(p<0.05).There was no statistical difference in immediate success rate and recent success rate between group C and group A and B.there were no significant statistical differences in the incidences of complications among the three groups(p>0.05).It was evaluated by echocardiography,the sizes of the left atriums were reduced significantly 12 months after operations than preoperations(p<0.05),and therewasnosignificantdifferenceinthemeasurementsof LVEF(p>0.05).Conclusion:1.It is safe and effective to import three-dimensional images of left atrial pulmonary veins into real-time X-ray scan system to guide radiofrequency ablation of paroxysmal atrial fibrillation.Compared with indirect angiography,direct angiography can improve the imaging quality of left atrial pulmonary vein,reduce intraoperative X-ray exposure and procedure time.The CT images of the left atrial pulmonary veins are directly integrated into the real-time X-ray screen after rectification,which has high imaging quality,clear images of pulmonary veins and left atrial appendages,short operation time,less X-ray exposure time and consumption of contrast agent.2.The combined using PPM and FAM to reconstruct left atrium and pulmonary vein model can highlight the images of the pulmonary veins,which is clear and lively.Compared with using PPM or FAM method alone,it reduces operation time and X-ray exposure time,improves the accuracy of antrum determination of circumferential pulmonary vein,and improves the targeting of catheter movement.3.In this paper,a variety of 3D imaging reconstruction methods for left atrial pulmonary veins were explored and applied.With the improvement of the methods,operation time and X-ray exposure time were shortened to some extent.However,there is no significant difference in the successful rate of atrial fibrillation ablation among three groups. |
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