1、CartoSoundCartoSound 在房性心律失常中的应用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在房性心律失常中的应用Fossa Ovalis Fossa Ovalis View From the LAA view, small movements (clockwise or counter clockwise) will optimize the fossa ovalis view. You may have to advance the catheter slightly in order to center the view. In
2、 preparation for guidance of the transseptal puncture (TSP) from this view, it may be necessary to engage the tension or lock function on the catheter. Also, use some posterior tilt and possibly right steering to optimize the fossa. Left Atrial Appendage View The left atrial appendage (LAA) is seen
3、in a similar plane to that of the Left Pulmonary Veins. The LAA is visualized using further clockwise rotation. The IAS, MV and LAA will usually come into view. The LAA is often visualized in the same plane as the mitral valve and will appear as an “out-pouching” from the LA.Left Atrial Appendage Le
4、ft Pulmonary Veins From the fossa view, you may need to disengage steering and rotate slightly clockwise. The left inferior pulmonary vein (LIPV) and left superior pulmonary vein (LSPV) are usually seen in the same plane. Utilize color Doppler to assist with identifying the pulmonary veins. Left Pul
5、monary Veins Right Pulmonary Veins From the left veins continue clockwise rotation.The right inferior pulmonary vein (RIPV) and the right superior pulmonary vein (RSPV) will appear close to the imaging surface of the ACUNAV image. In order to view the right superior pulmonary vein (RSPV) more longit
6、udinally, advance the catheter and continue clockwise rotation. In many cases the addition of anterior tilt and right/left steering at this time will further optimize the image. ansverseSinusTRANSVERSE SINUSThe third party trademarks used herein are trademarks of their respective ownersCavo Tricuspi
7、d Isthmus Cavo Tricuspid Isthmus View The isthmus view can be obtained by rotating the ACUNAV catheter clockwise from the crista view back to the “Home Position” view. Once this view is obtained, withdraw the ACUNAV catheter out of the patient slightly. This will allow an image of the eustachian rid
8、ge to be visualized. The isthmus is the area between the eustachian ridge and the tricuspid valve. The third party trademarks used herein are trademarks of their respective ownersCrista Terminalis View from the “Home Position,” rotate the ACUNAV catheter counter clockwise, or towards the patients ri
9、ght. The crista is an anterior structure, so the imaging face of the ACUNAV catheter is being rotated to look anteriorly . The crista is also a more superficial structure in relation to the ACUNAV imaging surface, so the “depth” knob may need to be adjusted to show only anatomical structures that ar
10、e closer to the catheter. A common depth to focus the crista is 30-50 cm. Crista TerminalisThe third party trademarks used herein are trademarks of their respective ownersPatent Foramen Ovale (PFO) Small flap-like opening in the inter-atrial septum from fetal circulation 1 in 4 people have a PFO tha
11、t persists throughout life Most people have no symptoms PFO is associated with stroke A defect (hole) between the two atriaSurgical vs. percutaneous repairAtrial Septal Defect (ASD)Atrial Septal DefectFenestrated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
12、间隔穿刺Tenting was called by TEE Do you see tenting with ACUNAV?Using ACUNAV to Guide Transseptal PunctureThe third party trademarks used herein are trademarks of their respective ownersUsing ACUNAV to Guide Transseptal PunctureWhere did the needle end up?The third party trademarks used herein are trad
13、emarks of their respective owners使用肝素盐水替代造影剂验证Ablation Catheter Visualization and Location Improves physician confidence with real-time visualization of the exact location of the ablation catheter 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，指导消融房间隔左房左心耳Callans DJ, Marchlinski
14、 FE, Ren JF. Left Atrial Thrombus Associated With Ablation For Atrial Fibrillation: Identification With Intracardiac Echocardiography. JACC. May 19, 2004; 43(10):1861-7Monitor for ThrombusThrombus is identified in 10.3% of left-sided casesMonitor for ThrombusPericardial Effusion TamponadeAtrial Flutter AblationTricuspid IsthmusCrista TerminalisPouch位置在Pouch部位的消融PouchCTI导管位于Pouch导管未贴靠导管贴靠欧式嵴欧式嵴消融导管消融导管消融导管消融导管贴靠在贴靠在CTI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
