Assessing epicardial substrate using intracardiac echocardiography during VT ablation.
Assessing epicardial substrate using intracardiac echocardiography during VT ablation.
复制标题
DOI：
10.1161/circep.111.963553
复制
发表时间：
2011-10
期刊：
影响因子：
--
通讯作者：
Marchlinski FE
中科院分区：
文献类型：
--
作者：
Bala R;Ren JF;Hutchinson MD;Desjardins B;Tschabrunn C;Gerstenfeld EP;Deo R;Dixit S;Garcia FC;Cooper J;Lin D;Riley MP;Tzou WS;Verdino R;Epstein AE;Callans DJ;Marchlinski FE
心内超声心动图（ICE）在确定室性心动过速（VT）的基质方面发挥了有限的作用。本研究的目的是评估ICE是否可以识别非缺血性心肌病（NICM）和VT患者（pts）的异常心外膜基质。我们研究了18例NICM和复发性VT患者，他们在ICE成像上发现了异常回声。对所有患者进行了详细的左心室内膜（ENDO）和心外膜（EPI）电解剖标测。分析心外膜低电压区（< 1.0mV）。将NICM组的ICE成像与30例结构正常心脏患者的对照组进行比较，这些患者接受了ICE成像以进行其他消融术。在18名NICM患者（53 ± 13岁，17名男性）（EF：37 ± 13%）中，通过ICE成像确定了侧部LV的回声增强。LV ENDO电解剖标测在9例患者中识别出正常电压，在9例患者中识别出至少一个融合低压区域[6.6 cm2（最小2.1至最大31.7 cm2）]（5例后外侧LV和4例瓣周LV）。详细的EPI标测显示所有18例患者（15例左心室后外侧和3例左心室外侧）的低电压区域[39 cm2（最小18.5至最大96.3 cm2）]和异常碎裂电描记图（EGM）。在所有患者中，通过电解剖标测识别的EPI瘢痕与ICE成像识别的回声区域相关。ICE成像未发现对照组中回声增强的区域。ICE成像发现LV侧壁回声增强，与异常EPI基质相关。这些结果表明，ICE成像可能有助于确定NICM中的EPI底物。
Intracardiac echocardiography (ICE) has played a limited role in defining the substrate for ventricular tachycardia (VT). The purpose of this study was to assess whether ICE could identify abnormal epicardial substrate in patients (pts) with nonischemic cardiomyopathy (NICM) and VT. We studied 18 pts with NICM and recurrent VT who had abnormal echogenicity identified on ICE imaging. Detailed LV endocardial (ENDO) and epicardial (EPI) electroanatomic mapping was performed in all pts. Low voltage areas (< 1.0mV) in the epicardium were analyzed. ICE imaging in the NICM group was compared to a control group of 30 pts with structurally normal hearts who underwent ICE imaging for other ablation procedures. In 18 pts (53 ± 13 years, 17 men) with NICM (EF: 37 ± 13%) increased echogenicity was identified in the lateral LV by ICE imaging. LV ENDO electroanatomic mapping identified normal voltage in 9 pts and at least one, confluent low voltage area [6.6 cm2 (minimum 2.1 to maximum 31.7 cm2)] in 9 pts (5 posterolateral LV and 4 perivalvular LV). Detailed EPI mapping revealed areas of low voltage [39 cm2 (minimum 18.5 to maximum 96.3 cm2)] and abnormal, fractionated electrograms (EGMs) in all 18 pts (15 posterolateral LV and 3 lateral LV). In all pts, the EPI scar identified by electroanatomic mapping correlated with the echogenic area identified on ICE imaging. ICE imaging identified no areas of increased echogenicity in the control group. ICE imaging identified increased echogenicity in the lateral wall of the LV that correlated to abnormal EPI substrate. These findings suggest that ICE imaging may be useful to identify EPI substrate in NICM.