Omnipolar Versus Bipolar Electrode Mapping in Patients With Atrial Fibrillation Undergoing Catheter Ablation.
Omnipolar Versus Bipolar Electrode Mapping in Patients With Atrial Fibrillation Undergoing Catheter Ablation.
复制标题
接受导管消融的心房颤动患者的全极与双极电极标测。
DOI：
10.1016/j.jacep.2022.08.026
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Piccini,JonathanP
中科院分区：
文献类型：
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作者：
Karatela,MahamF;Dowell,RobertS;Friedman,Daniel;Jackson,KevinP;Piccini,JonathanP
背景峰峰值双极电压随电极取向、分馏和碰撞事件而变化。本研究旨在比较持续性房颤(PerAF)和阵发性房颤(PAF)患者在窦性心律时左心房双极峰间电压和全极最大电压(Vmax)。方法应用双极和全极标测方法，对20例接受导管消融术的PerAF或PAF患者和9例心脏手术后已知瘢痕的患者进行基线电压图的绘制，以验证基于电压的瘢痕近似。低电压定义为0.5 mV，SCAR<；0.1 mV。将平均电压与未配对测试进行比较。用卡方检验比较低电压百分率和SCAR。结果受试者的平均年龄为62.2±9.9岁，34%为女性，41%有心力衰竭。全极标测的平均电压明显高于双极标测，低电压(PERAF：32.90%vs43.40%；PAF：19.20%vs25.60%)和SCAR(PERAF：7.72%vs12.10%；PAF：4.03%vs6.07%)(均P<0.0001)。经Bland-Altman分析，全极Vmax与双极Vmax有显著差异。在有已知SCAR的心房中，验证了SCAR和低电压近似，其中双极标测高估了低电压(P<；0.0001)和SCAR(P<；0.0001)的范围。结论全极标测可识别较高电压，且比常规双极标测对PERAF或PAF患者低电压和SCAR的检测具有更高的特异性。
BackgroundPeak-to-peak bipolar voltage varies with electrode orientation, fractionation, and collision events. Novel, omnipolar mapping is less dependent on electrode orientation but has limited data in humans.ObjectivesThis study sought to compare bipolar peak-to-peak voltage with omnipolar maximum voltage (Vmax) during sinus rhythm in the left atrium of patients with persistent (PerAF) or paroxysmal atrial fibrillation (PAF).MethodsBaseline voltage maps were generated with bipolar and omnipolar mapping in 20 patients undergoing de novo catheter ablation for PerAF or PAF and 9 patients with known scar from prior cardiac surgery, to validate voltage-based scar approximations. Low voltage was defined as <0.5 mV and scar <0.1 mV. Mean voltage was compared with unpairedttesting. Percent low voltage and scar were compared with chi-square testing. A point-to-point comparison was performed with Bland-Altman analysis.ResultsThe mean age was 62.2 ± 9.9 years, 34% were women, and 41% had heart failure. Omnipolar mapping identified significantly higher mean voltage than bipolar mapping and classified less points as low voltage (PerAF: 32.90% vs 43.40%; PAF: 19.20% vs 25.60%) and scar (PerAF: 7.72% vs 12.10%; PAF: 4.03% vs 6.07%) (allP <0.0001). Omnipolar Vmaxdisplayed significant disagreement with bipolar by Bland-Altman analysis. Scar and low-voltage approximations were validated in atria with known scar, in which bipolar mapping overestimated the extent of low voltage (P <0.0001) and scar (P <0.0001).ConclusionsOmnipolar mapping identifies higher voltage and has greater specificity for the detection of low voltage and scar than conventional bipolar mapping in patients with PerAF or PAF.