3-D-Mapping-Systeme und integrierte Bildgebung in der Elektrophysiologie

Zusammenfassung

Mit 3-D-Mapping-Systemen lässt sich die genaue Lage elektrophysiologischer Katheter im Herz bestimmen und bei kontinuierlicher Aufzeichnung ihrer Position zu einem anatomischen Bild zusammenfügen. Wird dann noch die intrakardiale „elektrische Information“ farbcodiert ergänzt, kann diese Darstellung sowohl mit Röntgen- als auch mit Schnittbildern fusioniert werden: ein komplexes Werkzeug für komplexe Arrhythmien.

Abstract

Successful mapping and ablation of cardiac arrhythmias is a challenging clinical task. For many years conventional pacing-maneuvers and activation mapping were the gold standard to identify and characterize arrhythmia mechanisms in electrophysiology procedures. Over the last decade, electrophysiology mapping and imaging technology has dramatically improved. In parallel to high density automated mapping, cardiac imaging and image integration tools are increasingly used to assess arrhythmia substrate and identify arrhythmia mechanisms. The aim of this review article is to provide an overview about current mapping technologies and to demonstrate their utilization in clinical practice.

Kernaussagen

• Die Katheterablation stellt heute für viele Arrhythmien (Vorhofflimmern, ventrikuläre Tachykardien) ein anerkanntes therapeutisches Standardverfahren dar.

• Zu Beginn jeder elektrophysiologischen Prozedur ist die vorliegende Arrhythmie präzise zu diagnostizieren.

• Für die Ablation werden spezialisierte Katheter verwendet, die mittels Kryotechnik oder Radiofrequenzenergie Herzgewebe veröden.

• Die Katheter steuert man durch klassische Fluoroskopie und durch 3-D-Mapping-Systeme. Letztere lokalisieren elektrophysiologische Katheter durch elektrische und/oder elektromagnetische Felder mit einer sehr hohen Genauigkeit (1 – 2 mm).

• Moderne 3-D-Mapping-Systeme ermöglichen dabei die Integration verschiedener Bildgebungsmodalitäten (präprozedurale CT/MRT-Anatomie, 3-D-Katheternavigation, Fluoroskopie) zu einer einheitlichen Ansicht.

• Darüber hinaus annotieren und interpretieren diese Systeme automatisiert intrakardiale Elektrogramme und erstellen zur Unterstützung des Untersuchers farbcodierte „Landkarten“ der untersuchten Arrhythmie.

Schlüsselwörter

3-D-Mapping-System - Bildintegration - Vorhofflimmern - ventrikuläre Tachykardie - Katheterablation - Rotormapping

Key words

cardiac arrhythmias - electrophysiology mapping - cardiac imaging - high density automated mapping

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