| Objective:(1)To define the spital characteristics of the pulmonary vein ostia (PVO) located with CARTO-Merge Technology during radiofrequency catheter ablation on atrial fibrillation (AF). (2)To evaluate the value of angiography on locateing PVO and to compare it with CARTO-Merge Technology.Methods:Fourty eight patients with AF who underwent circumferential pulmonary vein ablation (CPVA) guided by 3-dimensional electroanatomic mapping system (CARTO) were enrolled in this prospective study. We used three methods to localize PVO. Before left atrium (LA) reconstruction, four fluoroscopy PVO (FPVOs) with 12 points located by angiography were marked. After procedure, four real PVOs (RPVOs) with 12 points located within real ablation pointslines were idetified. Another four CT PVOs (CTPVOs) with 12 points marked on CT image were also identified. The LA volumes, angles of every RPVO planes and ipsilateral RPVO planes; angles between every FPVO planes, CTPVO planes and RPVO planes, distances from FPVO and CTPVO planes to RPVO planes were measured by special software. Angles and distances of PVOs planes located by three methods were analysed and compared, which practical diffrecial criterior is the calculated distance more than 5 mm from expected ablation points and real ablation line, to determine the value of PVOs localization by angiography.Results:1. LA diameter (LAD) of persistent AF is larger than that of paroxysmal AF(48.00±5.84 vs 40.79±4.69 cm~3,P< 0.001). Reconstructed LA volumes were fewer than that of CT. There was a positive correlation between LAD and LA volumes reconstructed by CARTO(r=0.871,P< 0.001).2. The anatomical speciality of RPVOs was described followed:the coronal plane angle (CPA) of right superior PV (RSPV) was 82.10±5.95 degree, the horizontal plane angle (HPA) of RSPV was 60.06±8.41 degree; the CPA of right inferior PV (RIPV) was 51.39±8.82 degree, the HPA of RIPV was 82.74±5.70 degree; the angle between RSPV and RIPV was 121.98±18.39 degree; the CPA of left superior PV (LSPV) was 72.75±12.3 degree; the HPA of LSPV was 82.74±5.70 degree; the CPA of left inferior PV (LIPV) was 38.02±10.48 degree; the HPA of LIPV was 75.20±9.09 degree; and the angle between LSPV and LIPV was 134.74±14.49 degree. There was a positive correlation between LAD and the CPA of LSPV.3. The angle of each PV between FPVOs and RPVOs was described followed:35.34±16.61 degree of RSPV,22.38±10.45 degree of RIPV, 20.42±12.54 degree of LSPV,19.23±13.71 degree of LIPV. The interplannar spacing between FPVOs and RPVOs was 3.04±2.37mm of RSPV,2.56±2.12mm of RIPV,2.49±1.86mm of LSPV,2.94±2.06mm of LIPV. The calculated distance from expected ablation points and real ablation line is-3.56～9.64mm.4. The angle of each PV between CTPVOs and RPVOs was described followed:11.10±6.64 degree of RSPV,13.56±7.93 degree of RIPV,15.42±7.04 degree of LSPV,13.51±7.65 degree of LIPV. The interplannar apcing between CTPVOs and RPVOs was 1.02±2.53mm of RSPV,2.30±2.10mm of RIPV,0.15±2.19mm of LSPV,2.87±1.86mm of LIPV. The calculated distance from expected ablation points and real ablation line is-3～5.00mm.Conclusion:1. PVOs marked by CT image can be used to reflect the anatomical speciality of each PV and to guide CPVA.2. The best observation position during PV angiography was 8 degree in right anterior oblique (RAO) of RSPV,39 degree in RAO of RIPV; 72 degree in left anterior oblique (LAO) of LSPV, 38 degree in LAO of LIPV.3. PVOs located by angiography can not be used to replace that located by CARTO-Merge. |
