心腔内超声结合全三维技术实施零射线个体化房间隔穿刺

Application of intracardiac echocardiography combined with total three-dimensional technique in zero-fluoroscopy individualized transseptal puncture

摘要

目的：评估经本研究整合及改进后的心腔内超声（intracardiac echocardiography,ICE）结合全三维（total 3-dimensional,T3D）技术实施零射线个体化房间隔穿刺的可行性和安全性。方法：入选2021年4月至2024年3月于重庆医科大学附属永川医院行房颤射频消融术的房颤患者112例。根据所采用房间隔穿刺方法按1∶1比例随机分为ICE+T3D组（n=56例）和ICE组（n=56例）。记录2组患者基线资料，统计2组患者的心房重建时间、冠状窦电极到位时间、房间隔穿刺过程中ICE扇面调整次数、房间隔穿刺时间、消融前预处理时间、并发症发生率、X线曝光时间及暴露剂量等参数。结果：2组患者基线资料差异无统计学意义。ICE+T3D组的房间隔穿刺过程中ICE扇面调整次数、房间隔穿刺时间少于ICE组[（1.70±0.63）次vs.(5.34±1.71)次，P<0.001]、[（3.66±1.09） min vs.(4.90±1.92) min,P<0.001]。但ICE+T3D组的心房重建时间、消融前预处理时间长于ICE组[（22.44±3.13） min vs.(12.34±2.12) min,P<0.001]、[（49.41±3.52） min vs.(37.65±4.04) min,P<0.001]。ICE+T3D组有43(76.8%)例患者在消融前预处理阶段实现零射线，有13例患者因推送导管困难而使用X射线，但这些患者的X射线暴露时间及剂量均小于ICE组[（1.68±0.72） min vs.(3.14±1.95) min,P=0.010]、[（6.28±2.78） mGy vs.(23.85±21.32) mGy,P=0.004]。在房间隔穿刺阶段中，ICE+T3D组全部实现零射线，而ICE组有45(80.4%)例实现零射线。并发症方面，2组均无心包填塞、误穿主动脉、栓塞等致命性并发症，均有1(1.8%)例血管穿刺并发症。结论：经本研究整合及改进后的ICE结合T3D技术可以安全可靠地实施零射线个体化房间隔穿刺。

Abstract

Objective To investigate the feasibility and safety of intracardiac echocardiography（ICE） combined with total three-dimensional（T3D） technique in zero-fluoroscopy individualized transseptal puncture. Methods A total of 112 patients with atrial fibrillation who underwent radiofrequency ablation in Yongchuan Hospital Affiliated to Chongqing Medical University from April 2021 to March 2024 were enrolled，and according to the method for transseptal puncture，they were randomly divided into ICE+T3D group with 56 patients and ICE group with 56 patients. The two groups were analyzed in terms of baseline data，time to atrial reconstruction，time to coronary sinus electrode placement，frequency of ICE probe adjustment during transseptal puncture，duration of transseptal puncture，pretreatment time before ablation，incidence rate of complications，and the duration and dosage of X-ray exposure. Results There were no significant differences in baseline data between the two groups. Compared with the ICE group，the ICE+T3D group had a significantly lower frequency of ICE probe adjustment during transseptal puncture（1.70±0.63 vs. 5.34±1.71，P<0.001） and the duration of transseptal puncture（3.66±1.09 min vs. 4.90±1.92 min，P<0.001）. Compared with the ICE group，the ICE+T3D group had significantly longer time to atrial reconstruction（22.44±3.13 min vs. 12.34±2.12 min，P<0.001） and pretreatment time before ablation（49.41±3.52 min vs. 37.65±4.04 min，P<0.001）. In the ICE+T3D group，43（76.8%） patients achieved zero radiation during pretreatment before ablation，and 13 patients received X-ray due to the difficulty in catheter placement； compared with the ICE group，the ICE+T3D group had a significantly shorter duration of X-ray exposure（1.68±0.72 min vs. 3.14±1.95 min，P=0.010） and a significantly lower dosage of X-ray exposure（6.28±2.78 mGy vs. 23.85±21.32 mGy，P=0.004）. During the stage of transseptal puncture，all patients in the ICE+T3D group achieved zero radiation，while 45 patients（80.4%） in the ICE patients received X-ray. In terms of complications，there were no life-threatening complications such as cardiac tamponade，perforation of the aorta by mistake，and embolization in either group，while there was one case（1.8%） of vascular complications in each group. Conclusions ICE combined with T3D after integration and improvement is a safe and reliable procedure for zero-fluoroscopy individualized transseptal puncture.

关键词

心房颤动 / 房间隔穿刺术 / 心腔内超声 / 全三维 / 零射线

Key words

atrial fibrillation / transseptal puncture / intracardiac echocardiography / total three-dimensional / zero-fluoroscopy

基金资助

北京市科技计划资助项目(Z181100001718174)

永川区自然科学基金资助项目(2023yc-jckx20020)