Identification of critical isthmus using coherent mapping in patients with scar-related atrial tachycardia
Identification of critical isthmus using coherent mapping in patients with scar-related atrial tachycardia
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DOI：
10.1111/jce.14457
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发表时间：
2020-06-01
影响因子：
2.7
通讯作者：
Chen, Shih-Ann
中科院分区：
文献类型：
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作者：
Vicera, Jennifer Jeanne B.;Lin, Yenn-Jiang;Chen, Shih-Ann
引言使用传统的心电图注释进行心脏电解剖标测（EAM）很难准确识别瘢痕相关房性心动过速（AT）患者的慢传导区域。估计相邻标测部位之间的延迟是激活标测图计算的潜在选项。我们描述了我们在复杂房速消融中使用CARTO 3相干标测（Biosense韦伯斯特公司）的初步经验。方法20例复杂房速患者（58 +/- 10岁，15例男性）。我们使用配备CONFIDENSE的CARTO 3系统和高分辨率标测导管（Biosense韦伯斯特Inc）创建了三维EAM。局部激动时间和相干标测图用于辅助识别传导峡部（CI）和局灶性起源部位。系统定义的慢或非传导区和CI，定义为隐匿性夹带（起搏后间期< 20 ms），CV < 0.3 m/s和局部碎裂电图进行了evaluated.Results 26复杂AT标测（平均：1.3 +/- 0.7地图/点; 4局灶性，22峡部依赖）。相干标测在识别消融终止心动过速的CI/爆发部位方面更好（96.2% vs 69.2%; P = 0.010），并确定了显著更高的CI（平均值/腔室2.0 +/- 1.1 vs 1.0 +/- 0.7; P < .001），宽度（19.8 +/- 10.5 vs 43.0 +/- 23.9 mm; P < .001）比传统标测更窄。25例（96.2%）在起源部位和CI部位消融成功，25%的患者长期复发。结论在峡部依赖性折返的瘢痕相关房性心动过速中，使用相邻标测部位的传导速度向量进行相干标测可显著提高CI部位的识别率。它可以与传统标测策略结合使用，以便于识别慢传导区域和作为消融重要目标的关键部位。
Introduction Accurate identification of slow conducting regions in patients with scar-related atrial tachycardia (AT) is difficult using conventional electrogram annotation for cardiac electroanatomic mapping (EAM). Estimating delays between neighboring mapping sites is a potential option for activation map computation. We describe our initial experience with CARTO 3 Coherent Mapping (Biosense Webster Inc,) in the ablation of complex ATs.Methods Twenty patients (58 +/- 10 y/o, 15 males) with complex ATs were included. We created three-dimensional EAMs using CARTO 3 system with CONFIDENSE and a high-resolution mapping catheter (Biosense Webster Inc). Local activation time and coherent maps were used to aid in the identification of conduction isthmus (CI) and focal origin sites. System-defined slow or nonconducting zones and CI, defined by concealed entrainment (postpacing interval < 20 ms), CV < 0.3 m/s and local fractionated electrograms were evaluated.Results Twenty-six complex ATs were mapped (mean: 1.3 +/- 0.7 maps/pt; 4 focal, 22 isthmus-dependent). Coherent mapping was better in identifying CI/breakout sites where ablation terminated the tachycardia (96.2% vs 69.2%; P = .010) and identified significantly more CI (mean/chamber 2.0 +/- 1.1 vs 1.0 +/- 0.7; P < .001) with narrower width (19.8 +/- 10.5 vs 43.0 +/- 23.9 mm; P < .001) than conventional mapping. Ablation at origin and CI sites was successful in 25 (96.2%) with long-term recurrence in 25%.Conclusions Coherent mapping with conduction velocity vectors derived from adjacent mapping sites significantly improved the identification of CI sites in scar-related ATs with isthmus-dependent re-entry better than conventional mapping. It may be used in conjunction with conventional mapping strategies to facilitate recognition of slow conduction areas and critical sites that are important targets of ablation.