Evaluation of the reentry vulnerability index to predict ventricular tachycardia circuits using high-density contact mapping
Evaluation of the reentry vulnerability index to predict ventricular tachycardia circuits using high-density contact mapping
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DOI：
10.1016/j.hrthm.2019.11.013
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发表时间：
2020-04-01
期刊：
影响因子：
5.5
通讯作者：
Lambiase, Pier D.
中科院分区：
文献类型：
--
作者：
Orini, Michele;Graham, Adam J.;Lambiase, Pier D.
识别致瘤部位以改善室性心动过速（VT）消融结果仍未解决。折返易损性指数（RVI）结合激动和复极时间来识别折返性心律失常起始的关键部位而不诱导VT。目的本研究的目的是首次评估RVI使用高密度接触标测识别VT起源部位的能力，并与功能基质的其他激动复极标记物进行比较。（16名男性; 72%缺血）进行了研究。在心室起搏期间记录单极电描记图并进行离线分析。测量激动时间（AT）、激动-恢复间期（ARI）和复极时间（RT）。脆弱性再入映射的基础上RVI和空间分布的AT，ARI，和RT。确定为脆弱的折返到VT网站的起源的距离进行了测量，与距离20毫米表示准确和不准确localizations. ResultsThe起源的18 VT（6夹带，12起搏映射）被确定。RVI标测图包括每例患者1012（408-2098）（中位数，第1-第3四分位数）个点。RVI准确定位了72.2%的室性心动过速起源部位，中位距离为5.1（3.2-10.1）mm。RVI定位不准确的频率明显低于AT（5.6% vs 33.3%;比值比0.12; P= 0.035）。与RVI相比，RT和ARI延长的部位与VT起源部位的距离显著增大，AT和ARI梯度最高的部位与VT起源部位的距离无显著性增大。激动复极化指标可以改善VT基底描绘并告知新的消融策略。
BACKGROUND Identifying arrhythmogenic sites to improve ventricular tachycardia (VT) ablation outcomes remains unresolved. The reentry vulnerability index (RVI) combines activation and repolarization timings to identify sites critical for reentrant arrhythmia initiation without inducing VT.OBJECTIVE The purpose of this study was to provide the first assessment of RVI's capability to identify VT sites of origin using high-density contact mapping and comparison with other activation-repolarization markers of functional substrate.METHODS Eighteen VT ablation patients (16 male; 72% ischemic) were studied. Unipolar electrograms were recorded during ventricular pacing and analyzed offline. Activation time (AT), activation-recovery interval (ARI), and repolarization time (RT) were measured. Vulnerability to reentry was mapped based on RVI and spatial distribution of AT, ARI, and RT. The distance from sites identified as vulnerable to reentry to the VT site of origin was measured, with distances 20 mm indicating accurate and inaccurate localization, respectively.RESULTS The origins of 18 VTs (6 entrainment, 12 pace-mapping) were identified. RVI maps included 1012 (408-2098) (median, 1st-3rd quartiles) points per patient. RVI accurately localized 72.2% VT sites of origin, with median distance of 5.1 (3.2-10.1) mm. Inaccurate localization was significantly less frequent for RVI than AT (5.6% vs 33.3%; odds ratio 0.12; P=.035). Compared to RVI, distance to VT sites of origin was significantly larger for sites showing prolonged RT and ARI and were nonsignificantly larger for sites showing highest AT and ARI gradients.CONCLUSION RVI identifies vulnerable regions closest to VT sites of origin. Activation-repolarization metrics may improve VT substrate delineation and inform novel ablation strategies.