Treatment of atrial fibrillation by radiofrequency ablation under the anatomical guidance by CT angiography of left atrium and pulmonary veins combined with esophagus
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摘要:
目的 分析左心房及肺静脉同步食管CT血管造影检查应用于指导心房颤动射频消融术中解剖位置的价值。 方法 选取我院2018年7月~2020年10月收治的61例心房颤动患者作为实验组，另选取31例非心房颤动的患者作为对照组，两组患者均接受左心房及肺静脉同步食管CT血管造影检查。对比两组患者各支肺静脉开口和食管径线、左心房大小和体积、食管走行分型。 结果 实验组肺静脉上下径右下开口显著高于对照组，肺静脉前后径右上开口显著低于对照组（P < 0.05）；两组患者食管跨左心房后壁距离、食管前壁到左心房的最短距离、左心房后壁厚度以及食道厚度差异均无统计学意义（P >0.05）；实验组比对照组左心房前后径和左心房体积更高（P < 0.05）。根据食管走行分型后发现，实验组Ia型39例，Ib型12例，Ic型11例，IIa型5例，IIb型3例，IIc型2例；对照组Ia型13例，Ib型6例，Ic型6例，IIa型3例，IIb型2例，IIc型1例。 结论 左心房及肺静脉同步食管CT血管造影检查应用于心房颤动射频消融术中价值较高，能够有效指导解剖位置，同时了解患者肺静脉和心房的变化情况，使手术安全性得到提高。 Abstract:Objective To explore the value of the CT angiography examination in the left atrium, pulmonary vein and esophagus in guiding the anatomical position during radiofrequency ablation of atrial fibrillation. Methods Sixty-one cases of atrial fibrillation and 31 cases of non-atrial fibrillation underwent CT angiography examination of the left atrium, pulmonary veins and esophagus in our hospital from July 2018 to October 2020 were enrolled. The patients were divided into set experimental group and control group. The diameters of pulmonary vein ostia, diameter of the esophagus, left atrium anteroposterior diameter and the left atrium volume as well as the anatomical types of easophagus were compared between two groups. Results The superoinferior diameters of right inferior pulmonary vein ostia of experimental group were larger than those of control group(P < 0.05). The anteroposterior diameters of right superior pulmonary vein ostia of experimental group were smaller than those of control group (P < 0.05). The mean length of left atrium posterior wall segment, median least distance between esophageal anterior wall and left atrium, mean thickness of left atrium posterior wall, and mean thickness of esophagus segment showed no significant difference between groups (P >0.05). The left atrium anteroposterior diameter and the left atrium volume were larger in experimental group than in control group (P < 0.05). The experimental group included 39 cases of type Ia, 12 cases of type Ib, 11 cases of type Ic, 5 cases of type IIa, 3 cases of type IIb and 2 cases of type IIc; while control group included 13 cases of type Ia, 6 cases of type Ib, 6 cases of type Ic, 3 cases of type IIa, 2 cases of type IIb and 1 case of type IIc. Conclusion Anatomical guidance by CT angiography of left atrium and pulmonary veins combined with esophagus has great value in the treatment of atrial fibrillation by radiofrequency ablation, which can effectively reveal the changes of pulmonary vein and atrium. -
Key words:
- left atrium /
- pulmonary veins /
- CT angiography /
- atrial fibrillation /
- anatomical location
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表 1 两组患者各支肺静脉开口径线对比
Table 1. Comparison of diameters of pulmonary vein openings between the two groups(mm, Mean±SD)
组别 肺静脉上下径 肺静脉前后径 左上开口 左下开口 右上开口 右下开口 左上开口 左下开口 右上开口 右下开口 实验组（n=61） 18.56±1.21 17.23±1.31 17.03±1.29 17.43±1.21 17.31±1.56 11.98±1.09 12.64±1.09 11.84±1.61 对照组（n=31） 18.34±1.14 16.98±1.29 17.31±1.04 12.23±1.08 17.25±1.61 12.15±1.13 18.32±1.75 12.01±1.53 t 0.840 1.182 1.047 20.179 0.172 0.698 19.125 0.486 P 0.403 0.240 0.297 < 0.001 0.863 0.486 < 0.001 0.627 
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表 2 两组患者食管径线对比
Table 2. Comparison of esophageal diameter between the two groups(mm, Mean±SD)
组别 食管跨左心房后壁距离 食管前壁到左心房的最短距离 左心房后壁厚度 食道厚度 实验组（n=61） 55.23±5.32 1.79±0.13 0.98±0.21 2.15±0.53 对照组（n=31） 54.86±5.18 1.82±0.14 1.01±0.18 2.09±0.62 t 0.318 1.019 0.678 0.484 P 0.751 0.310 0.499 0.629
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表 3 两组患者左心房大小和体积对比
Table 3. Comparison of left atrial size and volume between the two groups(Mean±SD)
组别 左心房前后径（mm） 左心房体积（mL） 实验组（n=61） 40.03±5.98 128.82±5.14 对照组（n=31） 35.86±5.04 75.74±5.64 t 3.326 45.303 P 0.001 < 0.001
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表 4 两组患者食管走行分型结果
Table 4. Results of esophageal course classification in two groups
组别 Ia Ib Ic IIa IIb IIc 实验组（n=61） 39 12 11 5 3 2 对照组（n=31） 13 6 6 3 2 1
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