Differentiating atrial tachycardias with centrifugal activation: Lessons from high-resolution mapping
Differentiating atrial tachycardias with centrifugal activation: Lessons from high-resolution mapping
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DOI：
10.1016/j.hrthm.2021.03.038
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发表时间：
2021-06-28
期刊：
影响因子：
5.5
通讯作者：
Jais, Pierre
中科院分区：
文献类型：
--
作者：
Takigawa, Masateru;Takagi, Takamitsu;Jais, Pierre
背景 离心激活并不总是局灶性房性心动过速（AT）（“真灶性”）的起源，而是来自其他结构的被动激活（“假灶性”）。 目的 我们旨在建立一种区分真灶性和假灶性心动过速的方法。 方法 在 35 例 AT 患者的 49 次离心激活中，进行 12 导联心电图、激活图、心房整体激活直方图 (GAH)、并分析局部电图。 GAH 通过周期长度展示激活区域和时间之间的关系，以标准化值显示，范围从 0（最小激活区域）到 1.0（最大激活区域）。 结果 在间隔区域观察到的 30 个离心激活中，6/30 (20.0%) 是真焦激活。其余 24/60 (80.0%) 为伪焦点，其中 23 (95.8%) 来自对面室。 P 波/扑动波持续时间，200 ms 区分真焦点和伪焦点（灵敏度 100%；特异性 54.5%；阳性预测值 33.3%；阴性预测值 100%）。多项突破排除了真焦AT的可能性。其他区分因素是最初 20 毫秒内的 5 mm2 激活区域和原点的典型 QS 模式电图。在间隔区域外观察到的 19 个离心激活中，7 个是真焦点，12 个是从心外膜结构退出的假焦点：12 个中的 10 个 (83.3%) 位于左心耳和房脊周围。颤振波，GAH 评分
BACKGROUND Centrifugal activation is not always the origin of a focal atrial tachycardia (AT) ("true-focal"), but passive activation from the other structures ("pseudo-focal").OBJECTIVE We aimed to establish a method to differentiate truefocal from pseudo-focal.METHODS In 49 centrifugal activations in 35 patients with AT, 12-lead electrocardiogram, activation map, atrial global activation histogram (GAH), and local electrograms were analyzed. GAH demonstrates the relation between the activation area and timing through the cycle length, displayed with a normalized value, ranging from 0 (smallest activation area) to 1.0 (largest activation area).RESULTS Of 30 centrifugal activations observed in the septal region, 6/30 (20.0%) were true-focal. The remaining 24/60 (80.0%) were pseudo-focal, of which 23 (95.8%) were from the opposite chamber. P-wave/flutter-wave duration, 200 ms discriminated true-focal from pseudo-focal (sensitivity 100%; specificity 54.5%; positive predictive value 33.3%; negative predictive value 100%). Multiple breakthrough ruled out the possibility of a true-focal AT. Other differentiating factors were an activation area within the initial 20 ms of,5 mm2 and a typical QS pattern electrogram at the origin. Of 19 centrifugal activations observed outside the septal regions, 7 were true-focal and 12 were pseudo-focal exited from an epicardial structure: 10 of 12 (83.3%) were located around the left atrial appendage and ridge. Flutter wave, GAH score