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Ensite系统指导下复杂心律失常的射频消融治疗

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Presentation on theme: "Ensite系统指导下复杂心律失常的射频消融治疗"— Presentation transcript:

1 Ensite系统指导下复杂心律失常的射频消融治疗
河南中医学院一附院心脏中心 解金红

2 EnSite系统标测模式 高密度采集、一跳标测 腔内信号同时采集 3360个单极电图 激动信息使用3D模式显示 顺序构图及采集心电信号
The EnSite system supports three modes of operation. First, the EnSite Array is a multielectrode array (MEA) catheter that displays high-density isopotential map. High resolution allows us to create a single beat, color-coded voltage map. Second, the EnSite NavX is a surface, patch-based technology that allows for 3D conventional contact mapping data and geometry. Compare the two systems: Internal array vs. external patches Non-contact (Array) vs.conventional contact (NavX) Both are open systems Both are capable of capturing any arrhythmia The third mode is the EnSite Verismo The EnSite Verismo segmentation tool is housed on the EnSite system software and is used to generate 3D models from any slice-based DICOM3 image data. This model can then be easily displayed and manipulated during and EP procedure using the EnSite system. (For more information, select the hyperlink icon.) 激动信息使用3D模式显示 顺序构图及采集心电信号 实时导航导管 (64 x 12) 2 2

3 Ensit指导下的射频消融治疗 NavX NavX 为 ESI 系统的一部分,实际为接触性标测系统。与 CARTO 系统不同的是 NavX 感受的是电场而不是磁场强度,同时它为连续采点模式,通过标测消融电极在心腔内表面的移动连续采集样点构建心脏的三维结构。

4 NavX定位基本原理 X, Y, Z三对电极片形成封闭式 电场 预设心腔固定电极为解剖参考 可导航任何电生理导管 空间精度<1mm 4
We have licensed the LocaLisa technology to use with the EnSite 3000 System. This is an electrically based, external system that would allow the location of any conventional catheter without the use of an EnSite catheter by using six surface patches. Geometry, labels, lesions and markers are all available, as well as the ability to create an isochronal map or a voltage map. In this first version of the feature, the user will decide to use either NavX patches or the EnSite Catheter for the study. Eventually this technology will support EnSite studies by allowing the user to create the geometry without the balloon in place, to reposition the balloon without re-creating the geometry, and to remove the balloon temporarily if required to navigate the ablation catheter. 4 4

5 多腔建模 可构建多达16个结构 自动拼接,消除假腔 各腔室均可进行标测 5

6 图像软件:Verismo 表面观 可在EnSite系统中应用 6
In the final step, Verismo converts the solid model of the blood pool to a tiled surface comprised of thousands of triangles. This model is similar to the geometries on the EnSite System and allows the use of familiar clinical functions such as translucency, clipping, and labeling. The completed model may be saved to the system hard drive or exported to CD. 6 6

7 融合(FUSION)功能 7

8 Ensite指导下的射频消融治疗 Ensite Array
非接触性标测系统,为 ESI 系统的一部分。通过放置表面排布有 64 个电极的 Array 球囊于心腔,通过标测消融导管所感知头端与球囊表面电极之间的电场强度及距离来确定心腔的最远边界,从而重建心脏的三维结构。重建完成后, Array 球囊可以感知瞬间的心电活动,即每一瞬间能收集近 3000 个心内电图,从而进行电压及激动顺序测定。这种特点很适合于那些非持续性心动过速及血动力学不稳定的心动过速。

9 EnSite Array 导航、建模、标测 9

10 EnSite Array基本功能 激动标测 电压标测 碎裂电位标测 动态等势图 静态等时图 逐点激动标测 动态基质标测(DSM)
逐点电压标测 碎裂电位标测 10

11 阵发性房颤的射频消融治疗 患者男性,29岁 飞行员,体检时发现心律失常 ECG示:Af 入院诊断:PAf 治疗选择:RFCA

12 常规术前准备: CT:左心房,肺静脉三维重建 TEE:排除血栓 ECHO:了解心脏结构及心功能 胸片及Holter检查

13 NavX+环肺电极下标测建模

14 环肺标测显示LSPV电位较大,考虑为LSPV驱动的PAF

15 行LSPV的RFCA

16 消融成功后行环肺静脉标测

17 阵发性房颤的射频消融治疗 老年男性,78岁 发作性心悸4年 ECG示:阵发性房颤 合并甲低,冠心病等 不能抗心律失常药物治疗
治疗选择:RFCA

18 常规术前准备: CT:左心房,肺静脉三维重建 TEE:排除血栓 ECHO:了解心脏结构及心功能 胸片及Holter检查

19 NavX+环肺电极下标测建模

20 行环RPV电隔离

21 行环LPV电隔离

22 消融完毕后行环肺静脉标测

23 术后动态监测未见房性心律失常

24 持续性房速的射频消融治疗 男性,29岁 心悸持续不缓解 平素心率> 100bpm

25 怀疑LA起源 术中电生理检查

26 常规左房造影

27 NAVX下标测建模

28 环肺电极多点同时行激动顺序标测(LAT)

29 放电终止AT

30 消融靶点位置

31 放电3S终止AT

32 放电终止AT

33 小结: NavX系统 手术时间控制在<1.5小时 单大头逐点激动顺序标测 多电极同时标测(高密度标测)
于游离壁靶点区域共放电4次,损伤范围小 通过ISO检验,达到消融终点 可有效缩短标测时间,并可精确定位! LAA房速消融并不难!

34 EnSite Array 指导下的局灶性室速射频消融治疗
患者青年女性,22岁, 学生 反复心悸4年 ECG示:频发室早, 提示RVOT起源,靠 间隔部

35 RVOT PVC’s 通过0.035的交换导丝进入肺动脉分支后,将EnSite Array置入RVOT
在模型上标识ea 和 bo 在 bo 处起搏标测

36 PVC Array置入前后 PVC Array置入前

37 RVOT 模型 AP View LAO View PA View RAO View

38 PVC位于模型后壁 PA View

39 最早激动点与突破口 最早激动点(ea: Early activation )与突破口(bo:Breakout)

40

41

42 临床 PVC BO处起搏标测

43 在BO处消融放电2次后

44 第3次消融放电在第2个 BO处

45 消融放电3次后 异丙肾上腺素诱发/被Array碰触出的不同与临床形态的PVC

46 谢谢


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