CartoSound-在房性心律失常中的应用课件

CartoSound在房性心律失常中的应用CartoSound在房性心律失常中的应用1工欲善其事必先利其器工欲善其事必先利其器2CartoSound在房性心律失常中的应用对心房结构的认识ICE指导下的房间隔穿刺CartoSound下的左房建模与消融食道位置的识别并发症的监测CartoSound在右房中的应用CartoSound在房性心律失常中的应用对心房结构的认识3FossaOvalis

FossaOvalisView–FromtheLAAview,smallmovements(clockwiseorcounterclockwise)willoptimizethefossaovalisview.Youmayhavetoadvancethecatheterslightlyinordertocentertheview.Inpreparationforguidanceofthetransseptalpuncture(TSP)fromthisview,itmaybenecessarytoengagethetensionorlockfunctiononthecatheter.Also,usesomeposteriortiltandpossiblyrightsteeringtooptimizethefossa.

FossaOvalis FossaOvalisVie4

LeftAtrialAppendageView–Theleftatrialappendage(LAA)isseeninasimilarplanetothatoftheLeftPulmonaryVeins.TheLAAisvisualizedusingfurtherclockwiserotation.TheIAS,MVandLAAwillusuallycomeintoview.TheLAAisoftenvisualizedinthesameplaneasthemitralvalveandwillappearasan“out-pouching”fromtheLA.LeftAtrialAppendage

LeftAtrialAppendageView–5LeftPulmonaryVeins–Fromthefossaview,youmayneedtodisengagesteeringandrotateslightlyclockwise.Theleftinferiorpulmonaryvein(LIPV)andleftsuperiorpulmonaryvein(LSPV)areusuallyseeninthesameplane.UtilizecolorDopplertoassistwithidentifyingthepulmonaryveins.

LeftPulmonaryVeins

LeftPulmonaryVeins–Fromth6RightPulmonaryVeins–Fromtheleftveinscontinueclockwiserotation.Therightinferiorpulmonaryvein(RIPV)andtherightsuperiorpulmonaryvein(RSPV)willappearclosetotheimagingsurfaceoftheACUNAV™image.Inordertoviewtherightsuperiorpulmonaryvein(RSPV)morelongitudinally,advancethecatheterandcontinueclockwiserotation.Inmanycasestheadditionofanteriortiltandright/leftsteeringatthistimewillfurtheroptimizetheimage.

RightPulmonaryVeins

ansverseSinusTRANSVERSESINUSThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersRightPulmonaryVeins–Fromt7CavoTricuspidIsthmus

CavoTricuspid

IsthmusView–TheisthmusviewcanbeobtainedbyrotatingtheACUNAV™catheterclockwisefromthecristaviewbacktothe“HomePosition”view.Oncethisviewisobtained,withdrawtheACUNAV™catheteroutofthepatientslightly.Thiswillallowanimageoftheeustachianridgetobevisualized.Theisthmusistheareabetweentheeustachianridgeandthetricuspidvalve.

Thethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersCavoTricuspidIsthmus CavoT8

CristaTerminalisView–fromthe“HomePosition,”rotatetheACUNAV™cathetercounterclockwise,ortowardsthepatient’sright.Thecristaisananteriorstructure,sotheimagingfaceoftheACUNAV™catheterisbeingrotatedtolookanteriorly.ThecristaisalsoamoresuperficialstructureinrelationtotheACUNAV™

imagingsurface,sothe“depth”knobmayneedtobeadjustedtoshowonlyanatomicalstructuresthatareclosertothecatheter.Acommondepthtofocusthecristais30-50cm.

CristaTerminalisThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveowners CristaTerminalisView–from9AtrialSeptalAbnormalitiesPatentForamenOvale(PFO)Smallflap-likeopeningintheinter-atrialseptumfromfetalcirculation1in4peoplehaveaPFOthatpersiststhroughoutlifeMostpeoplehavenosymptomsPFOisassociatedwithstrokeAdefect(hole)betweenthetwoatriaSurgicalvs.percutaneousrepairAtrialSeptalDefect(ASD)AtrialSeptalAbnormalitiesPat10SeptalTunnel(PFO)SeptalTunnel(PFO)11SeptalTunnel(PFO)SeptalTunnel(PFO)12AtrialSeptalDefectFenestratedAtrialSeptalDefectFenestrate13AneurysmalAtrialSeptumAneurysmalAtrialSeptum14ICE指导下的房间隔穿刺——更安全卵圆孔和穿刺针可视构建出相邻解剖结构减少x线使用盐水替代造影剂验证在三维壳上标记卵圆窝提高安全性和优化位置应对复杂穿刺情况保护患者和医生减少肾脏负荷方便导管回到左房三维超声下房间隔穿刺ICE指导下的房间隔穿刺——更安全卵圆孔和穿刺针可视提高安全15TentingwascalledbyTEE–DoyouseetentingwithACUNAV™???UsingACUNAV™toGuideTransseptalPunctureThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersTentingwascalledbyTEE–Do16TransseptalPunctureTransseptalPuncture17UsingACUNAV™toGuideTransseptalPunctureWheredidtheneedleendup?Thethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersUsingACUNAV™toGuideTransse18使用肝素盐水替代造影剂验证TransseptalPuncture使用肝素盐水替代造影剂验证TransseptalPunct19SOUNDSTAR构建左房三维模型SOUNDSTAR构建左房三维模型20SOUNDSTAR构建左房三维模型SOUNDSTAR构建左房三维模型21CartoSound左房建模——SoundMap法CartoSound左房建模——SoundMap法22CartoSound左房建模——SoundMap+AF2.0CartoSound左房建模——SoundMap+AF2.023CartoSound左房建模—SoundMap

+CTmergeCartoSound左房建模—SoundMap

24AblationCatheterVisualizationandLocationImprovesphysicianconfidencewithreal-timevisualizationoftheexactlocationoftheablationcatheterClinicalBenefits–CARTOSOUND®AblationCatheterVisualizatio25CASE

CartoSound指导下的房颤消融（我院经验）患者，男性，61岁病史：ParoxysmalAF5y既往史：高血压UCG：LA42mmLV48mmRA34mmLVEF0.6术前诊断：1.心律失常阵发性房颤2.高血压病3级（极高危）CASE

CartoSound指导下的房颤消融（我院经验）26CreatingSoundMapCreatingSoundMap27TransseptalPuncture监视穿刺针的位置选择出针方向和力度观察房间隔形态变化视觉结合手感判断是否穿过使用盐水替代造影剂TransseptalPuncture监视穿刺针的位置28FAMvs.SoundMap大头详细FAM肺静脉可以代替定口超声指导：更真实的特殊结构FAMvs.SoundMap29DuringAblation-消融DuringAblation-消融30DuringAblation–消融点分布LPV偏心耳侧消融模型轮廓和消融点有距离RPV后壁完美直观的勾勒肺静脉开口，指导消融DuringAblation–消融点分布LPV31DuringAblation-大头监视DuringAblation-大头监视32DuringAblation超声与三维影像实时对应消融点与大头在超声图上显影DuringAblation超声与三维影像实时对应33EsophagusEsophagus34EsophagealLocalizationEsophagealLocalization35EsophagealLocalizationEsophagealLocalization36诊断LAA血栓SOUNDSTAR导管：耐受性好RAA（位于右房）和LAA图像质量高（位于肺动脉）TEE诊断心耳血栓，当：患者不能耐受图像质量差时，SOUNDSTAR是TEE的可靠替代手段诊断LAA血栓SOUNDSTAR导管：37CartoSound检查LAA血栓房间隔左房左心耳CartoSound检查LAA血栓房间隔左房左心耳38CallansDJ,MarchlinskiFE,RenJF.LeftAtrialThrombusAssociatedWithAblationForAtrialFibrillation:IdentificationWithIntracardiacEchocardiography.JACC.May19,2004;43(10):1861-7MonitorforThrombusThrombusisidentifiedin10.3%ofleft-sidedcasesCallansDJ,MarchlinskiFE,Re39MonitorforThrombusMonitorforThrombus40PericardialEffusionTamponadePericardialEffusionTamponade41CARTOSOUND在右房房扑

和房速手术中的应用CARTOSOUND在右房房扑

和房速手术中的应用42AtrialFlutterAblationTricuspidIsthmusCristaTerminalisAtrialFlutterAblationTricusp43RightAtrialMappingRightAtrialMapping44RightAtrialMappingRightAtrialMapping45RightAtrialMappingRightAtrialMapping46RightAtrialFlutterRightAtrialFlutter47房扑：CTI解剖和Pouch位置Pouch位置在Pouch部位的消融PouchCTI导管位于Pouch房扑：CTI解剖和Pouch位置Pouch位置在Pouch部48房扑：判断导管在CTI在欧式嵴的贴靠情况导管未贴靠导管贴靠欧式嵴消融导管消融导管贴靠在CTI房扑：判断导管在CTI在欧式嵴的贴靠情况导管未贴靠导管贴靠欧49CARTOSOUND下的CTI消融方法CARTOSOUND下的CTI消融方法50复杂房速：发现未知

复杂病例精确、自信辨别解剖结构适用于全心腔的标测策略复杂房速：发现未知

复杂病例精确、自信适用于全心腔的51总结缩短电生理手术学习曲线提高手术成功率保证手术安全性降低X线曝光和造影剂用量精确、简单、安全CARTOSOUND+SOUNDSTAR总结缩短电生理手术学习曲线提高手术成功率保证手术安全性降52谢谢CartoSound-在房性心律失常中的应用课件53CartoSound在房性心律失常中的应用CartoSound在房性心律失常中的应用54工欲善其事必先利其器工欲善其事必先利其器55CartoSound在房性心律失常中的应用对心房结构的认识ICE指导下的房间隔穿刺CartoSound下的左房建模与消融食道位置的识别并发症的监测CartoSound在右房中的应用CartoSound在房性心律失常中的应用对心房结构的认识56FossaOvalis

FossaOvalisView–FromtheLAAview,smallmovements(clockwiseorcounterclockwise)willoptimizethefossaovalisview.Youmayhavetoadvancethecatheterslightlyinordertocentertheview.Inpreparationforguidanceofthetransseptalpuncture(TSP)fromthisview,itmaybenecessarytoengagethetensionorlockfunctiononthecatheter.Also,usesomeposteriortiltandpossiblyrightsteeringtooptimizethefossa.

FossaOvalis FossaOvalisVie57

LeftAtrialAppendageView–Theleftatrialappendage(LAA)isseeninasimilarplanetothatoftheLeftPulmonaryVeins.TheLAAisvisualizedusingfurtherclockwiserotation.TheIAS,MVandLAAwillusuallycomeintoview.TheLAAisoftenvisualizedinthesameplaneasthemitralvalveandwillappearasan“out-pouching”fromtheLA.LeftAtrialAppendage

LeftAtrialAppendageView–58LeftPulmonaryVeins–Fromthefossaview,youmayneedtodisengagesteeringandrotateslightlyclockwise.Theleftinferiorpulmonaryvein(LIPV)andleftsuperiorpulmonaryvein(LSPV)areusuallyseeninthesameplane.UtilizecolorDopplertoassistwithidentifyingthepulmonaryveins.

LeftPulmonaryVeins

LeftPulmonaryVeins–Fromth59RightPulmonaryVeins–Fromtheleftveinscontinueclockwiserotation.Therightinferiorpulmonaryvein(RIPV)andtherightsuperiorpulmonaryvein(RSPV)willappearclosetotheimagingsurfaceoftheACUNAV™image.Inordertoviewtherightsuperiorpulmonaryvein(RSPV)morelongitudinally,advancethecatheterandcontinueclockwiserotation.Inmanycasestheadditionofanteriortiltandright/leftsteeringatthistimewillfurtheroptimizetheimage.

RightPulmonaryVeins

ansverseSinusTRANSVERSESINUSThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersRightPulmonaryVeins–Fromt60CavoTricuspidIsthmus

CavoTricuspid

IsthmusView–TheisthmusviewcanbeobtainedbyrotatingtheACUNAV™catheterclockwisefromthecristaviewbacktothe“HomePosition”view.Oncethisviewisobtained,withdrawtheACUNAV™catheteroutofthepatientslightly.Thiswillallowanimageoftheeustachianridgetobevisualized.Theisthmusistheareabetweentheeustachianridgeandthetricuspidvalve.

Thethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersCavoTricuspidIsthmus CavoT61

CristaTerminalisView–fromthe“HomePosition,”rotatetheACUNAV™cathetercounterclockwise,ortowardsthepatient’sright.Thecristaisananteriorstructure,sotheimagingfaceoftheACUNAV™catheterisbeingrotatedtolookanteriorly.ThecristaisalsoamoresuperficialstructureinrelationtotheACUNAV™

imagingsurface,sothe“depth”knobmayneedtobeadjustedtoshowonlyanatomicalstructuresthatareclosertothecatheter.Acommondepthtofocusthecristais30-50cm.

CristaTerminalisThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveowners CristaTerminalisView–from62AtrialSeptalAbnormalitiesPatentForamenOvale(PFO)Smallflap-likeopeningintheinter-atrialseptumfromfetalcirculation1in4peoplehaveaPFOthatpersiststhroughoutlifeMostpeoplehavenosymptomsPFOisassociatedwithstrokeAdefect(hole)betweenthetwoatriaSurgicalvs.percutaneousrepairAtrialSeptalDefect(ASD)AtrialSeptalAbnormalitiesPat63SeptalTunnel(PFO)SeptalTunnel(PFO)64SeptalTunnel(PFO)SeptalTunnel(PFO)65AtrialSeptalDefectFenestratedAtrialSeptalDefectFenestrate66AneurysmalAtrialSeptumAneurysmalAtrialSeptum67ICE指导下的房间隔穿刺——更安全卵圆孔和穿刺针可视构建出相邻解剖结构减少x线使用盐水替代造影剂验证在三维壳上标记卵圆窝提高安全性和优化位置应对复杂穿刺情况保护患者和医生减少肾脏负荷方便导管回到左房三维超声下房间隔穿刺ICE指导下的房间隔穿刺——更安全卵圆孔和穿刺针可视提高安全68TentingwascalledbyTEE–DoyouseetentingwithACUNAV™???UsingACUNAV™toGuideTransseptalPunctureThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersTentingwascalledbyTEE–Do69TransseptalPunctureTransseptalPuncture70UsingACUNAV™toGuideTransseptalPunctureWheredidtheneedleendup?Thethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersUsingACUNAV™toGuideTransse71使用肝素盐水替代造影剂验证TransseptalPuncture使用肝素盐水替代造影剂验证TransseptalPunct72SOUNDSTAR构建左房三维模型SOUNDSTAR构建左房三维模型73SOUNDSTAR构建左房三维模型SOUNDSTAR构建左房三维模型74CartoSound左房建模——SoundMap法CartoSound左房建模——SoundMap法75CartoSound左房建模——SoundMap+AF2.0CartoSound左房建模——SoundMap+AF2.076CartoSound左房建模—SoundMap

+CTmergeCartoSound左房建模—SoundMap

77AblationCatheterVisualizationandLocationImprovesphysicianconfidencewithreal-timevisualizationoftheexactlocationoftheablationcatheterClinicalBenefits–CARTOSOUND®AblationCatheterVisualizatio78CASE

CartoSound指导下的房颤消融（我院经验）患者，男性，61岁病史：ParoxysmalAF5y既往史：高血压UCG：LA42mmLV48mmRA34mmLVEF0.6术前诊断：1.心律失常阵发性房颤2.高血压病3级（极高危）CASE

CartoSound指导下的房颤消融（我院经验）79CreatingSoundMapCreatingSoundMap80TransseptalPuncture监视穿刺针的位置选择出针方向和力度观察房间隔形态变化视觉结合手感判断是否穿过使用盐水替代造影剂TransseptalPuncture监视穿刺针的位置81FAMvs.SoundMap大头详细FAM肺静脉可以代替定口超声指导：更真实的特殊结构FAMvs.SoundMap82DuringAblation-消融DuringAblation-消融83DuringAblation–消融点分布LPV偏心耳侧消融模型轮廓和消融点有距离RPV后壁完美直观的勾勒肺静脉开口，指导消融DuringAblation–消融点分布LPV84DuringAblation-大头监视DuringAblation-大头监视85DuringAblation超声与三维影像实时对应消融点与大头在超声图上显影DuringAblation超声与三维影像实时对应86EsophagusEsophagus8