Practical Considerations of Mapping Persistent Atrial Fibrillation With Whole-Chamber Basket Catheters.
Practical Considerations of Mapping Persistent Atrial Fibrillation With Whole-Chamber Basket Catheters.
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DOI：
10.1016/j.jacep.2015.09.017
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发表时间：
2016-02-01
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影响因子：
--
通讯作者：
Wright, Matthew
中科院分区：
文献类型：
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作者：
Laughner, Jacob;Shome, Shibaji;Wright, Matthew
目的：本研究旨在评估持续性房颤(房颤)患者记录的单极心房肌电(AEGM)的篮形导管部署、导管-组织接触和时间-空间稳定性。背景：使用多电极篮形导管对人体房颤进行全景标测可以识别房颤的来源。尽管使用这种技术的临床结果具有挑衅性，但其有效性仍然存在疑问。方法：数据来自多中心Starlight(房颤数据的信号传输以指导人类治疗)试验期间接受房颤导管消融的患者(N=25)(NCT01765075)。分别在基础房颤、消融后和窦性心律时用篮状导管记录左右aEGM信号。对篮子部署、峰峰值电压以及电信号的稳定性和组织进行了数据分析。通过时频分析(TFA)评价心电信号的稳定性和组织性。结果：篮形导管放置在心房时出现赤道聚集现象。右心房花键间距为1.7~64.0 mm，左房篮间距为1.5~85.08 mm。大约三分之一的标测电极未能显示出中值峰峰值电压>；2*低电压阈值。22例右房患者中13例(59.09%)右房出现时间-空间稳定性和组织性，22例左房中10例(45.45%)出现时间-空间稳定性和组织性。结论：尽管部署不良且有大量低压电极，但约一半的标测患者可观察到稳定性和组织性。尽管这项研究表明篮形导管对于特定患者的房颤标测有局限性，但在一些持续性房颤患者中会发生一致的激活，这可能适用于高密度标测技术。
OBJECTIVES: This study sought to evaluate basket catheter deployment, catheter-tissue contact, and time-space stability of unipolar atrial electrograms (aEGMs) recorded in persistent atrial fibrillation (AF) patients.BACKGROUND: Panoramic mapping of human AF using multiple-electrode basket catheters may identify AF sources. Although clinical results using this technique are provocative, questions remain about its effectiveness.METHODS: Data were collected from patients (N= 25) undergoing catheter ablation for AF during the multicenter STARLIGHT (Signal Transfer of Atrial Fibrillation Data to Guide Human Treatment) trial (NCT01765075). Left and right aEGM signals were recorded using basket catheters during baseline AF, following ablation and during sinus rhythm. Data were analyzed for basket deployment, peak-to-peak voltage, and electrogram stability and organization. Electrogram stability and organization were evaluated via time-frequency analysis (TFA).RESULTS: Basket catheters displayed equatorial bunching when deployed in atria. Interspline spacing ranged from 1.7 to 64.0 mm in the right atrial and from 1.5 to 85.08 mm in the left atrial basket. Approximately one-third of mapping electrodes failed to demonstrate a median peak-to-peak voltage >2* the low-voltage threshold. Time-space stability and organization was observed in 13 of 22 (59.09%) right atrial and 10 of 22 (45.45%) left atrial baskets.CONCLUSIONS: Despite poor deployment and a large number of low-voltage electrodes, stability and organization was observed in about one-half of the mapped patients. Although this study suggests that basket catheters have limitations for patient-specific AF mapping, concordant activation occurs in some persistent AF patients, which may be amenable to high-density mapping techniques.