Validation of a novel mapping system and utility for mapping complex atrial tachycardias
Validation of a novel mapping system and utility for mapping complex atrial tachycardias
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DOI：
10.1111/jce.13437
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发表时间：
2018-03-01
影响因子：
2.7
通讯作者：
Schilling, R. J.
中科院分区：
文献类型：
--
作者：
Honarbakhsh, S.;Hunter, R. J.;Schilling, R. J.
前言：本研究试图验证一种使用全腔篮式导管(CARTOFINDER，Biosense Webster)的新型波前标测系统。该系统在(1)标测心房起搏和(2)标测房性心动过速(AT)的复杂波前模式方面得到验证。方法和结果：包括接受导管消融的房性心动过速和持续性房颤患者。采用极篮导管采集单极信号，经CARTOFINDER标测系统处理后生成动态波前传播图。左心房从四个部位起搏，以显示局灶性激活。22名患者(16名房颤患者和6名房颤患者在消融过程中终止为房颤)被纳入研究。该测绘系统总共绘制了172幅地图。它正确地识别了所有起搏地图中的心房起搏位置。准确定位左、右心房9个焦点/微折返性房颤和18个大折返性房颤。第三个和第四个观察者通过CARTOFINDER图独立识别心房起搏的位置和AT机制，同时与传统的激活图盲。结论：通过从心房起搏标测焦点激活模式，这种新的标测系统是有效的。该系统还有效地绘制了有疤痕的心房患者在一系列AT中的复杂波前图案。因此，该系统可用于房颤的标测和消融，并有可能用于标测房颤的波前激活。
Introduction: This study sought to validate a novel wavefront mapping system utilizing whole-chamber basket catheters (CARTOFINDER, Biosense Webster). The system was validated in terms of (1) mapping atrial-paced beats and (2) mapping complex wavefront patterns in atrial tachycardia (AT).Methods and results: Patients undergoing catheter ablation for AT and persistent AF were included. A 64-pole-basket catheter was used to acquire unipolar signals that were processed by CARTOFINDER mapping system to generate dynamic wavefront propagation maps. The left atrium was paced from four sites to demonstrate focal activation. ATs were mapped with the mechanism confirmed by conventional mapping, entrainment, and response to ablation.Twenty-two patients were included in the study (16 with AT and 6 with AF initially who terminated to AT during ablation). In total, 172 maps were created with the mapping system. It correctly identified atrial-pacing sites in all paced maps. It accurately mapped 9 focal/microreentrant and 18 macroreentrant ATs both in the left and right atrium. A third and fourth observer independently identified the sites of atrial pacing and the AT mechanism from the CARTOFINDER maps, while being blinded to the conventional activation maps.Conclusions: This novel mapping system was effectively validated by mapping focal activation patterns from atrial-paced beats. The system was also effective in mapping complex wavefront patterns in a range of ATs in patients with scarred atria. The system may therefore be of practical use in the mapping and ablation of AT and could have potential for mapping wavefront activations in AF.