STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping
STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping
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DOI：
10.1111/jce.14201
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发表时间：
2019-10-03
影响因子：
2.7
通讯作者：
Hunter, Ross J.
中科院分区：
文献类型：
--
作者：
Honarbakhsh, Shohreh;Schilling, Richard J.;Hunter, Ross J.
引言在持续性房颤（AF）中映射局部驱动因素的最佳方法仍不清楚。本研究的目的是应用一种新的向量映射方法，称为随机轨迹分析的分级信号（星星）在AF。方法和结果持续性AF消融患者。在使用篮状导管创建的全局星星标测图上识别的早期激动部位（ESA）用于指导肺静脉隔离（PVI）后的房颤消融。所有患者还具有使用>= 10个30秒的PentaRay记录创建的连续星星图。离线验证了这些方法识别研究定义消融反应（AF终止或周期长度[CL]减慢>= 30 ms）的ESA目标的能力。纳入了32例患者，其中在全球星星标测图上识别出92个ESA，83个靶点中有73个显示出消融反应（24个AF终止和49个CL减缓）。在连续的星星地图上也识别出了73个ESA中的61个（83.6%）。这些显示出更大的一致性（P <0.001），在肺静脉隔离前后观察到（P <0.001），并且更可能与消融时房颤终止相关（P = 0.007）。序贯标测检测消融反应ESA的灵敏度和特异性分别为84.9%（95%置信区间[CI] = 74.6-92.2）和90.0%（95% CI = 55.5-99.8）。在19.4 ± 3.7个月的随访期间，28例（80%）患者无AF/房性心动过速。结论星星标测一致地识别出所有患者的ESA，消融反应与ESA作为驱动部位相一致。使用顺序记录成功地识别了重要的ESA。
Introduction The optimal way to map localized drivers in persistent atrial fibrillation (AF) remains unclear. The objective of the study was to apply a novel vector mapping approach called Stochastic Trajectory Analysis of Ranked signals (STAR) in AF. Methods and Results Patients having persistent AF ablation were included. Early sites of activation (ESA) identified on global STAR maps created with basket catheters were used to guide AF ablation post-pulmonary vein isolation (PVI). All patients also had sequential STAR maps created with >= 10 PentaRay recordings of 30 seconds. These were validated offline in their ability to identify the ESA targeted with a study-defined ablation response (AF termination or cycle length [CL] slowing of >= 30 ms). Thirty-two patients were included in whom 92 ESA were identified on the global STAR maps, with 73 of 83 targeted sites demonstrating an ablation response (24 AF termination and 49 CL slowing). Sixty-one out of 73 (83.6%) ESA were also identified on the sequential STAR maps. These showed greater consistency (P < .001), were seen pre- and post-PVI (P < .001) and were more likely to be associated with AF termination on ablation (P = .007). The sensitivity and specificity of sequential mapping for the detection of ESA with an ablation response was 84.9% (95% confidence interval [CI] = 74.6-92.2) and 90.0% (95% CI = 55.5-99.8), respectively. During a follow-up of 19.4 +/- 3.7 months, 28 (80%) patients were free from AF/atrial tachycardia. Conclusions STAR mapping consistently identified ESA in all patients and the ablation response was compatible with ESA being driver sites. Mechanistically important ESA were successfully identified using sequential recordings.