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工欲善其事必先利其器CartoSound

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FossaOvalis

Fossa

OvalisView–FromtheLAAview,smallmovements(clockwiseorcounterclockwise)willoptimizethefossa

ovalisview.Youmayhavetoadvancethecatheterslightlyinordertocentertheview.Inpreparationforguidanceofthetransseptalpuncture(TSP)fromthisview,itmaybenecessarytoengagethetensionorlockfunctiononthecatheter.Also,usesomeposteriortiltandpossiblyrightsteeringtooptimizethefossa.

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

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

LeftPulmonaryVeins

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

RightPulmonaryVeins

ansverseSinusTRANSVERSESINUSThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersCavoTricuspidIsthmus

CavoTricuspid

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

Thethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveowners

Crista

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

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

Crista

TerminalisThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersAtrial

SeptalAbnormalitiesPatentForamenOvale(PFO)Smallflap-likeopeningintheinter-atrialseptumfromfetalcirculation1in4peoplehaveaPFOthatpersiststhroughoutlifeMostpeoplehavenosymptomsPFOisassociatedwithstrokeAdefect(hole)betweenthetwoatriaSurgicalvs.percutaneousrepairAtrial

SeptalDefect(ASD)SeptalTunnel(PFO)SeptalTunnel(PFO)Atrial

SeptalDefectFenestratedAneurysmal

AtrialSeptumICE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TentingwascalledbyTEE–DoyouseetentingwithACUNAV™???UsingACUNAV™toGuideTransseptalPunctureThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersTransseptalPunctureUsingACUNAV™toGuideTransseptalPunctureWheredidtheneedleendup?Thethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveowners使用肝素盐水替代造影剂验证TransseptalPunctureSOUNDSTAR构建左房三维模型SOUNDSTAR构建左房三维模型CartoSound左房建模——SoundMap法CartoSound左房建模——SoundMap+AF2.0CartoSound左房建模—SoundMap

+CTmergeAblationCatheterVisualizationandLocationImprovesphysicianconfidencewithreal-timevisualizationoftheexactlocationoftheablationcatheterClinicalBenefits–CARTOSOUND®CASE

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）

CreatingSoundMapTransseptalPuncture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FAMvs.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

DuringAblation-消融DuringAblation–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-大头监视

DuringAblation超声与三维影像实时对应消融点与大头在超声图上显影EsophagusEsophagealLocalizationEsophagealLocalization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CartoSound检查LAA血栓房间隔左房左心耳CallansDJ,MarchlinskiFE,RenJF.LeftAtrialThrombusAssociatedWithAblationForAtrialFibrillation:IdentificationWithIntracardiacEchocardiography.JACC.