摘要
目的 通过与病理解剖对比,研究非接触式标测系统(EnSite 3000系统)在窦性心律下完成猪心肌梗死后疤痕区标测和导航线性消融的准确性。方法 运用非开胸PTCA球囊堵闭法造成6只猪心肌梗死后10～16周,在其左心室置入一EnSite 3000球囊,构建左心室的三维几何模型,通过动态疤痕标测确定左心室心肌梗死后疤痕区、疤痕边缘与正常非梗死部位交界区和非梗死区域,记录分析这些部位心内电图的差异;运用导航系统指引线性消融,并将系统所确定的疤痕区及导航的消融线与病理分析相对照。结果 系统所确定的疤痕区的面积为(8.4±4.7)cm^2,与病理解剖平均心内膜梗死面积(8.6±3.9)cm^2相比差异无显著性(P>0.05),梗死的部位及边缘均与解剖高度一致。共记录分析系统模拟的408个位点心内双极电图,在梗死区内所记录到的心内电图振幅明显较低(1.3±0.4)mV、持续时间较长(86.4±27.3)ms,且图形更为碎裂,后电位成分较多。在非梗死区心内电图表现为振幅高(5.7±2.1)mV、持续时间短(42.6±7.7)ms、呈单相或双相图形,无碎裂成分出现。交界区的心内电图振幅(3.5±1.8)mV、时间(67.1±16.5)ms和形态均介于两者之间。结论 EnSite 3000系统在窦性心律下可较精确地标测出疤痕组织,能明确解剖学异常与电生理变化的关系。
Objective To investigate the accuracy of scar mapping and navigation of the noncontact mapping system through correlation with pathology analysis. Methods Detailed endocardial mapping were made in 6 pigs 10～16 weeks after left anterior desending coronary artery occluded by noncontact mapping system. Infarct areas, border between normal and infarct and remote areas were determined using dynamic scar mapping, and electrograms were recorded. Linear ablation was guided by the system. Infarct sizes and ablation lines were compared with pathological measurement. Results Mean infarct size determined by the system was(8.4±4.7) cm^2 which had no difference from the size by pathological measurement. The infarct location and the border were correlated to pathological analysis. Compared with remote sites, electrograms from infarct sites had smaller amplitudes[(1.3±0.4) mV vs (5.7±2.1) mV, P<0.001], longer durations [(86.4±27.3) ms vs (42.6±7.7) ms], and more frequent notched or late components. Border zone electrograms were intermediate in amplitude and duration. Conclusions Noncontact mapping system (EnSite 3000) during sinus rhythm allows accurate 3D characterization of infarction architecture and defines the relationship of electrophysiological and anatomic abnormalities. This technique may prove useful in devising anatomically based strategies for ablation of scar-related ventricular tachycardia.
出处
《中华心律失常学杂志》
2004年第2期105-108,共4页
Chinese Journal of Cardiac Arrhythmias
基金
江苏省政府重点资助课题(BJ98084)
关键词
非接触式标测系统
心肌梗死
心内膜
标测
电生理
Noncontact mapping system
Myocardial infarction
Ventricular tachycardia
Mapping
Electrophysiology
