![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/2183a5ef1e354e9280efa61f4cc39727.png)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/6c926651a8894f24b9fa8a2de7ace6f9.gif)
导语
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/5dd3be9a9b534591b148348c38a2aa9c.jpg)
心房颤动 (以下简称“房颤”) 是临床上最常见的心律失常。房颤的发病率随着年龄增加而增高。《中国心房颤动防治现状蓝皮书 2018》数据显示,大约1%的患者年龄<60岁,70-80岁年龄组的发病率高达11%。房颤使卒中风险增加5倍,占中风的20%以上,已成为日益严重的公众健康问题。导管消融术是目前临床上治疗房颤的主要手段,在治疗指南中的地位也逐年提高。
心腔内超声(Intracardiac Echocardiography,ICE)对减少或消除心脏消融手术期间的X线暴露至关重要。ICE可以对导管位置和心脏结构进行实时监测,并且可以识别X线或三维解剖标测系统无法识别的解剖结构,同时还可以实时监测心脏压塞等并发症。
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/6c926651a8894f24b9fa8a2de7ace6f9.gif)
ICE超声扇面选择
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/5dd3be9a9b534591b148348c38a2aa9c.jpg)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/b7fb3711bd9d4614ade1df2cbf722b38.png)
基准位 Home View
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/affbfb08616846ef850a48452c79338e.gif)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/442b9a2919a643e9ad9b3d2bbd952262.gif)
图中可见结构:右心房、三尖瓣峡部、三尖瓣前叶和后叶、右心室、右心室流出道。
ICE导管操作:从下腔静脉送入右心房,顺时针旋转手柄至观察到三尖瓣的位置即为Home View位。
Home View位是所有心内超声操作的起点,此时ICE导管手柄上‘三杠一线’。
有的导管操作都是轻微动作,如果无法确认当时位置,可回到Home View位重新开始。
左心耳位 LAA View
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/9f13ec457def4e5d9cb5bd2c931262d8.gif)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/5dd4475731774d3497ac11b81d308d93.gif)
图中可见结构:右心房、房间隔、左心房、左心室、二尖瓣、左心耳、冠状窦口部。
ICE导管操作:从 Home View位 顺时针旋转手柄。
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/5437d154389648fea43bfd0ea43301af.png)
左肺静脉位 LPV View
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/c71828313d8142ed834c0282bc1eae3b.gif)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/0f55dfb568fe4b61a4b3d8df0be5b02f.gif)
图中可见结构:卵圆窝、左心房、左侧肺静脉和降主动脉。
ICE导管操作:从 LAA View位 顺时针旋转手柄。
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/de5aafb1fc1f4cbba975e39ea3ddfa8f.png)
食道位 Eso View
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/d0d872574c074f07bd62795d8329665f.gif)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/987e8fb182a34a8db3ccbb0c987d308d.gif)
图中可见结构:房间隔、左心房、食道和降主动脉。
ICE导管操作:从 LPV View位 顺时针旋转手柄。
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/dcbf9b836e8e46d58dda7d119e3d2357.png)
右肺静脉位 RPV View
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/4ad4b0ab3e05401392438ad084b5de25.gif)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/6b8e56f3671d424ab171502df27df8b8.gif)
图中可见结构:右心房、房间隔、左心房、右侧肺静脉。
ICE导管操作:从 Eso View位 顺时针旋转手柄。
右心耳位 RAA View
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/3471090462eb4f4db46e82701b7edccf.gif)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/e506281e7ab94ae3bf782122755d44cc.gif)
图中可见结构:右心房、右心耳。
ICE导管操作:从 RPV View位 顺时针旋转手柄。
小结
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/7b3facaacdba4a4094655e2e8950ecbf.png)
各个不同术式相对应房间隔穿刺位点选择[1]
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/6f70e174b3ab4c37b68ed17e2e86dd37.png)
判断房间隔前后技术要点:
靠前:可见左心耳、二尖瓣及冠状窦的开口
中间:可见心房中部和左肺静脉
靠后:可见左心房后壁
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/6c926651a8894f24b9fa8a2de7ace6f9.gif)
ICE指导下房间隔穿刺流程总结
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/5dd3be9a9b534591b148348c38a2aa9c.jpg)
导管操作要点
• ICE导管放置在Home View位
• 顺时针旋转手柄直至观察到LAA
• 从LAA处顺时针旋转手柄观察到一前(左上肺静脉LSPV)一后(左下肺静脉LIPV)
• 出现兔耳征或LSPV尚未消失且出现LIPV即可选择最薄卵圆孔进行穿刺
ICE相比于DSA优势在于增加安全性
ICE导管指导房间隔穿刺时需要注意ICE导管的位置和方向造成的偏差
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/5b1dbde5287e4e47ae3e7e96fd53e421.png)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/6c926651a8894f24b9fa8a2de7ace6f9.gif)
参考资料
1、Alkhouli M. Transseptal Techniques for Emerging Structural Heart Interventions. JACC Cardiovasc Interv. 2016 Dec 26;9(24):2465-2480.
2、Jingquan Z. Intracardiac echocardiography Chinese expert consensus. Front Cardiovasc Med. 2022 Oct 6;9:1012731.
下期预告
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/5dd3be9a9b534591b148348c38a2aa9c.jpg)
• 雅培ICE如何进行术前筛查和术中监测
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/110ed02ef87f494fbb13d5d74d9fd3ac.png)
黄松群 教授
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/12/14/5dd3be9a9b534591b148348c38a2aa9c.jpg)
海军军医大学第一附属医院
(上海长海医院)
心内科 副主任医师
• 临床医学博士,毕业于浙江大学,从事心律失常的介入治疗10余年,曾至德国德累斯顿和莱比锡中心交流
• 中国生物医学工程学会心律学分会青年委员,上海心律学会委员,上海生物医学工程学会心电学组委员,全国医药技术市场协会心电信息学分会委员,中国医药信息学理事会心电信息学术委员会委员
• 房颤冷冻消融全球带教术者,左心耳封堵全球带教术者,中国心律大会“冷冻之星”、冷冻球囊房颤消融实践菁英奖、中国房颤中心“房颤管理优秀工作者”、“沪上名医赴闽百人行动”特聘专家、福建省“师带徒”特聘专家、福建省人民医院“医疗技术指导顾问”
• 主持国家自然科学基金、上海市自然科学基金、卫健委科研基金共3项,获得国家发明专利3项、实用新型专利1项,在国内外知名期刊发表论文30余篇,主编专著1部,参编专著5部