Pace Mapping Using Body Surface Potential Maps to Guide Catheter Ablation of Accessory Pathways in Patients With Wolff‐Parkinson‐White Syndrome
Pace Mapping Using Body Surface Potential Maps to Guide Catheter Ablation of Accessory Pathways in Patients With Wolff‐Parkinson‐White Syndrome
复制标题
使用体表电位图进行起搏测绘来指导沃尔夫-帕金森-怀特综合征患者辅助通路的导管消融
作者：
M. Dubuc;R. Nadeau;G. Tremblay;T. Kus;F. Molin;P. Savard
研究背景：采用体表电位图（BSPMs）进行起搏定位技术，用于指导Wolff-Parkinson-White综合征（WPW）患者在辅助通路（AP）心室插入点的消融导管定位。方法与结果对30例WPW患者进行研究。用分布在整个躯干表面的63根导线记录BSPMs。首先将用于射频消融的导管放置在Δ波期间记录的BSPMs预测的心室预兴奋部位附近。然后在起搏过程中记录BSPMs，通过对预兴奋与起搏时BSPMs的比较，判断起搏部位相对于预兴奋部位是过于前位还是过于后位，并相应移动导管。这一过程反复进行，直到预激发和节律BSPMs高度相关（r≥0.8），然后尝试消融。在记录第一次起搏BSPM和在成功消融部位起搏BSPM之间持续54±44分钟的调查后，28例患者有可能成功消融AP。左侧自由壁通道患者比其他位置通道患者所需的调查时间更短（46±9 vs 100±25分钟，p=0.031）。使用多极导管起搏评估BSPM起搏图的敏感性，在起搏点相距仅5mm的心跳中观察到BSPM的显著变化。结论sbspm起搏标测使我们在较短的调查时间内获得93%的成功率，提供了标准12导联心电图无法获得的重要信息，是一种自我纠正程序，可以降低由于躯干或心脏形状的个体差异而导致的BSPM改变的重要性，并且仅适用于AP表现为顺行传导的患者。
BackgroundA pace mapping technique using body surface potential maps (BSPMs) was developed to guide the positioning of an ablation catheter at the ventricular insertion point of accessory pathways (AP) in patients with the Wolff-Parkinson-White syndrome (WPW). Methods and ResultsThe study was performed on 30 WPW patients. BSPMs were recorded with 63 leads distributed over the entire torso surface. The catheter used for radiofrequency ablation was first placed in the vicinity of the ventricular preexcitation site predicted by BSPMs recorded during the Δ wave. BSPMs were then recorded during pacing with this catheter, the comparison between the preexcited and paced BSPMs indicated whether the pacing site was too anterior or posterior with respect to the preexcitation site, and the catheter was moved accordingly. This process was repeated until the preexcited and paced BSPMs were highly correlated (r≥0.8), and ablation then was attempted. It was possible to successfully ablate the AP in 28 patients after an investigation that lasted 54±44 minutes between the recording of the first paced BSPM and that of the BSPM paced at the successful ablation site. Patients with left free wall pathways needed less investigation time compared with patients with pathways of other locations (46±9 versus 100±25 minutes, p=0.031). The sensitivity of BSPM pace mapping was assessed using pacing with a multipolar catheter, and significant changes were observed on the BSPMs for beats with pacing sites that were only 5 mm apart. ConclusionsBSPM pace mapping allowed us to achieve a 93% success rate with short investigation durations, provides significant information that cannot be obtained with the standard 12-lead ECG, is a self-correcting procedure that reduces the importance of BSPM alterations due to individual differences in the shape of the torso or heart, and is applicable only to patients with AP showing antegrade conduction.
影响因子：
158.5
作者：
JACKMAN, WM;WANG, XZ;LAZZARA, R
通讯作者：
LAZZARA, R