Characterization of the infarct substrate and ventricular tachycardia circuits with noncontact unipolar mapping in a porcine model of myocardial infarction.
Characterization of the infarct substrate and ventricular tachycardia circuits with noncontact unipolar mapping in a porcine model of myocardial infarction.
复制标题
在猪心肌梗塞模型中采用非接触式单极标测来表征梗塞基质和室性心动过速回路。
DOI：
10.1016/j.hrthm.2005.11.007
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发表时间：
2006
期刊：
影响因子：
5.5
通讯作者：
Callans,DavidJ
中科院分区：
文献类型：
--
作者：
Jacobson,JasonT;Afonso,ValtinoX;Eisenman,Gregory;Schultz,JohnR;Lazar,Sorin;Michele,JohnJ;Josephson,MarkE;Callans,DavidJ
心肌梗死后室性心动过速（VT）的常规映射是有限的患者血流动力学不耐受或noninducibleVT.EQUITIVESThe本研究的目的是开发一种独特的策略，使用非接触单极映射，以确定梗死基板和VT circuits.METHODS动态基板映射（DSM）进行了7头猪与愈合的前壁心肌梗死。该技术将基底定义为在窦性心律和在梗死周围起搏期间识别的低电压区域的交叉点。在基底内也进行起搏以确定出口部位。在所有动物中均发现前心尖透壁瘢痕。基底定义使用了平均三个起搏部位。DSM测量的平均面积（± SD）为18.4 ± 8.8 cm 2，病理测量的平均面积（± SD）为15.4 ± 6.9 cm 2（P > 0.5）。在基质内平均起搏4.5个部位。18个起搏波阵面中有10个在起搏区域附近离开基底，7个在远处离开，1个有两个出口。在5只动物中诱导VT（每只动物1.6种形态）。除1例室性心动过速外，在内膜基底边界发现了回路出口部位。VT出口部位位于（n = 6）或靠近（n = 3）起搏出口部位。梗死动物的基底、边界和非基底区域之间的电描记图电压与对照动物相比有显著差异。在两个对照动物中没有底物被鉴定。结论DSM是一种可靠的方法，在这个模型中梗死底物定位。基底内起搏可以预测室性心动过速出口部位，并可能被证明对心肌梗死后无法标测的室性心动过速的消融有用。
BACKGROUNDConventional mapping of ventricular tachycardia (VT) after myocardial infarction is limited in patients with hemodynamically untolerated or noninducible VT.OBJECTIVESThe purpose of this study was to develop a unique strategy using noncontact unipolar mapping to define infarct substrate and VT circuits.METHODSDynamic substrate mapping (DSM) was performed in seven pigs with healed anterior myocardial infarction. This technique defined substrate as the intersection of low-voltage areas identified in sinus rhythm and during pacing around the infarct. Pacing was also performed within the substrate to determine exit sites.RESULTSAnteroapical transmural scar was identified in all animals. A mean of three pacing sites was used for substrate definition. The mean area (± SD) was 18.4 ± 8.8 cm2by DSM and 15.4 ± 6.9 cm2by pathology (P >.5). A mean of 4.5 sites was paced within substrate. Ten of 18 paced wavefronts exited substrate adjacent to the pacing area, seven exited at distant areas, and one had two exits. VT was induced in five animals (1.6 morphologies per animal). Except for one VT, circuit exit sites were identified at substrate borders on the endocardium. VT exit sites were at (n = 6) or near (n = 3) a pacing exit site. Electrogram voltages differed significantly between substrate, border, and nonsubstrate areas in infarcted animals and in comparison with control animals. No substrate was identified in two control animals.CONCLUSIONDSM is a reliable method for infarct substrate localization in this model. Pacing within substrate can predict VT exit sites and may prove useful for ablation of unmappable VT after myocardial infarction.