Insights from preclinical ultra high-density electroanatomical sinus node mapping
Insights from preclinical ultra high-density electroanatomical sinus node mapping
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DOI：
10.1093/europace/euu276
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发表时间：
2015-03-01
期刊：
影响因子：
6.1
通讯作者：
Hindricks, Gerhard
中科院分区：
文献类型：
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作者：
Bollmann, Andreas;Hilbert, Sebastian;Hindricks, Gerhard
目的：虽然导管消融窦房结修饰是治疗不适当性窦性心动过速的一种成熟的治疗方法，但对窦房结解剖和功能的了解不完全，而且电解剖制图数据也有限。最近，一种自动、超高分辨率的测绘系统被提出，以准确、快速地识别右心房（RA）的几何形状和激活模式，但尚未进行窦房结激活的详细评估，这是本研究的目的之一。我们比较了以往在动物和人类中进行的窦结定位研究的临床经验，并讨论了导管消融的潜在临床意义。方法和结果在麻醉和通气条件下，14头猪采用心律失常（TM）制图系统绘制心内膜RA图30张，心外RA图2张，无并发症，测定最早激活部位（EAS）和窦爆（SBO）。基线时，EAS和SBO位于端嵴中部（n -= 6）或下三分之一（n -= 8）的前部，所有病例均表现为单中心激活模式。传导通路分为前、后、上、下三种，个体间在传导方向、传导距离和传导时间上存在显著差异。奥昔那林、心得安或胺碘酮在模式不一致的动物之间改变了心内膜激活，差异很大。1例奥昔那林输注后出现多中心激活。在两只动物中进行了连续的心内膜和心外膜高密度RA测绘，并显示窦结在心内膜和心外膜地图上的激活高度一致。结论：超高密度成像可以快速、简单、详细地评估窦结的激活情况。未来的研究显然需要评估新的定位和消融策略，以提高对窦结疾病的理解和更好的结果。
Aims Although sinus node modification by catheter ablation is an established therapy for the treatment of inappropriate sinus tachycardia, there is incomplete understanding of sinus node anatomy and function but also limited electroanatomical mapping data. Recently, an automatic, ultra high-resolution mapping system has been presented to accurately and quickly identify right atrial (RA) geometry and activation patterns but detailed assessment of sinus node activation has not been performed which was one aim of this study. Prectinical experiences are compared with previous sinus node mapping studies in animals and humans, and potential clinical implications for catheter ablation are discussed.Methods and results In anaesthetized and ventilated 14 pigs, 30 endocardial and 2 eipcardial RA maps were generated using the Rhythmia (TM) mapping system without complications and earliestactivation sites (EAS) and sinus break-out (SBO) were determined. At baseline, EAS and SBO were located anterior to the middle (n -= 6) or Lower third (n -= 8) of the crista terminalis exhibiting a unicentric activation pattern in all cases. Conduction pathways were directed anterior, posterior, superior, or inferior with substantial inter-individual variation in direction, pathway distance, and conduction time. OrciprenaLine, propranolol, or amiodarone shifted endocardial activation with considerable variation between animals with inconsistent patterns. Multicentric activation was found in one case after orciprenaLine infusion. Sequential endocardiaL and epicardial high-density mapping of the RA was performed in two animals and showed a high congruence of the sinus node activation in the endo- and the epicardial map.Conclustion Ultra high-density mapping allows fast, simple, and very detailed assessment of sinus node activation. Future studies are clearly needed to evaluate novel mapping and ablation strategies for an improved understanding of sinus node disease and better outcomes.