以解剖学为基础的左心室顶部切除,以心内回声指导的早发性心室复合体为指导
Nikhil Sharma1, Kristie M Coleman1, Gregory Cunn1
1Department of Electrophysiology, Lenox Hill Hospital, Northwell Health, New York, NY, USA.
The Journal of innovations in cardiac rhythm management
|March 6, 2024
概括
从左心室顶部进行过早心室收缩的导管切除具有挑战性. 使用心内回声学进行的三维重建改善了切除成功率,达到85%的PVC消除.
科学领域:
- 心脏病学 心脏病学
- 医疗成像医学成像
- 电力生理学 电力生理学
背景情况:
- 从左心室顶部 (LVS) 进行过早心室收缩 (PVCs) 的导管切除技术上很困难.
- 解剖学上的挑战和内部的起源使得切除位的目标变得复杂.
研究的目的:
- 评估心内回声学 (ICE) 和CARTOSOUND对于重建LVS和指导切除的实用性.
- 评估这种方法在实现PVC消除方面的有效性.
主要方法:
- 对20名因疑似LVS起源而接受PVC切除术的患者的回顾性审查 (2021年1月至2022年12月).
- 使用ICE可视化解剖学和定位起源地点 (SOO) 的三维LVS重建.
- 除针对最早的激活部位,根据解剖近距离和信号特征进行调整.
主要成果:
- 20名患者中有17名 (85%) 在12个月内完全消除了PVC.
- 在12名患者中观察到复发,最早的激活部位在瓦萨尔瓦鼻,冠状动脉系统或左心室内心内.
- 成功的切除部位有时与最初的最早信号有所不同,这凸显了需要详细的解剖绘制的需要.
结论:
- 使用ICE的三维LVS重建为PVC切除提供了关键的解剖学和电生理学指导.
- 这种技术增强了识别和消灭具有挑战性的LVS起源的能力,导致高成功率.
- 这种方法有助于识别废弃目标,即使初始信号是低于最佳的或误导性的.
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