三维电解剖标测系统（参考）.ppt

缺血性室速 Ischemia VT Ventricular Tachycardia Sustained Tolerable Mappabale VT Linear Lesions for Unmappable VT Marchlinski et.al. (Circulation. 2000;101:1288.) The hypothesis: In patients with unmappable, unimorphic VT, The abnormal endocardium can be defined using detailed sinus rhythm voltage mapping, Linear ablation lesions that repeatedly and/or selectively interrupt the border zone of abnormal endocardium could control VT. Voltage Maps with Linear Lesions  crossing Border Zones Marchlinski et.al. (Circulation. 2000;101:1288.) Voltage Maps with Linear  Lesions crossing Border Zones Marchlinski et.al. (Circulation. 2000;101:1288.) The “Maze” Procedure Dr. Ernst et.al. (Circulation. 1999;100:2085-2092.) 局灶性房颤或特发性房颤的异位兴奋点多数起源于肺静脉口.CARTO可以在较短时间内标测出肺静脉的走向以及肺静脉出口并根据电激动图确定最早触发点, 行热点消融可以有效终止房颤. 局灶性房颤 Focal AF Atrial Fibrillation - using CARTO Multi chamber Mapping PV Focal ablation Focus Diastolic Potential 慢性房颤 Chronic AF 在CARTO系统指引下可以作出连续穿壁性消融线,这一点已形成共识. 目前欧州一些中心正尝试用CARTO划线,来孤立四个肺静脉并沿线消融以切断全部折返环从而终止房颤 并已有初步可喜结果.我们称之为电学隔离迷宫术. Atrial Fibrillation - using CARTO Right Atrium - Maze RAO View Bottom View Right Atrium Atrial Fibrillation - using CARTO Left Atrium - Maze AP View Superior Posterior View Left Atrium “Maze” of Left Atrium Pappone et.al. (Circulation. 1999;100:1203-1208). Pre Ablation Map Post Ablation ReMap Left Atrium – Encircling the PVs Results from Milano (reported by Pappone, ESC 90% free of Afib, paroxysmal and chronic patients Atrial Fibrillation - using CARTO 旁道 Pathway 采用热点标测,在瓣环下寻找最早激动点进行消融. 可应用于常规射频消融非常困难的游离壁appendage处的肌束性旁道. CARTO map of Accessory Pathways 现今EP手术面临的挑战 二维影像 影像重叠 大量暴光放射线 心腔内导管头端的位置及方向不明 心脏内解剖影像不理想 复杂心律失常的手术时间较长 无法评估线性阻断的确实性 Carto系统的解决办法 心腔的三维电解剖标测 对期前电位,激动时间,以及峡部和折返环缓慢传导区或其他兴趣区有直观显示,并有精确的定位记忆 非放射线条件下可实时显示导管头端位置及方向 设定线性消融方案,并用Carto指引实施线性消融 直观评估线性阻断效果,并用电压标测评估透壁性消融和双向阻滞效果 Carto 系统的主要优势 精确度高 0.7 mm 显著减少放射线 治疗快速性心律失常的新的可能方法,特别对折返性心律失常有显著优势 增加射频的安