Effect of bipolar electrode orientation on local electrogram properties
Effect of bipolar electrode orientation on local electrogram properties
复制标题
DOI：
10.1016/j.hrthm.2018.07.020
复制
发表时间：
2018-12-01
期刊：
影响因子：
5.5
通讯作者：
Jais, Pierre
中科院分区：
文献类型：
--
作者：
Takigawa, Masateru;Relan, Jatin;Jais, Pierre
背景双极方向对电描记图（EGMs）的直接影响尚不清楚.目的本研究的目的是检查对角正交双极的EGMs的变化.方法HD-32 Grid导管（Abbott，Minneapolis，MN）可以在保持极间距离和中心不变的情况下评估双极方向的影响。通过比较来自每对相对电极的局部EGM（例如，A1-B3（东南方向[SE]）vs A3-B1（东北方向[NE]）。结果共分析了2042个部位（梗死区544个，边缘区488个，正常区1010个）的4084个EGM（每个方向1个）。使用每对相对电极测量的较高和较低电压存在显著差异（1.10 mV [0.43-2.56 mV] vs 0.69 mV [0.28-1.58 mV]; P，.0001），中位变异为0.28 mV（0.11-0.80 mV）（31.7% [16.0%-48.9%]）。电压变化最大为48.7%（37.7%-61.6%）（P，. 0001）在激活波阵面垂直于一个双极方向和平行于另一个双极方向的位置上。NE中电压<0.5mV的位点有594个（82.6%），电压> 1.5mV的位点有539个（77.1%）与SE中的电压范围相同。而NE区电压在0.5- 1.5mV的624个位点中，只有348个位点（55.8%）与SE区电压保持一致。在2042个部位中，592个部位（29.0%）检测到局部心室异常活动（LAVA），主要分布在边境地区。一个方向共有177例（29.9%）LAVA漏诊，另一个方向共有180例（30.4%）LAVA漏诊。当NE中检测到的415个LAVA（70.1%）被定义为参考时，415个LAVA中的235个（56.6%）与SE中检测到的LAVA相匹配。
BACKGROUND The direct effect of bipolar orientation on electrograms (EGMs) remains unknown.OBJECTIVE The purpose of this study was to examine the variation of EGMs with diagonally orthogonal bipoles.METHODS The HD-32 Grid catheter (Abbott, Minneapolis, MN) can assess the effect of bipolar orientation while keeping the interelectrode distance and center unchanged. Seven sheep with anterior myocardial infarction were analyzed using diagonally orthogonal electrode pairs across splines by comparing local EGMs from each pair of opposing electrodes {eg. A1-B3 (southeast direction [SE]) vs A3-B1 (northeast direction [NE])}.RESULTS A total of 4084 EGMs (1 in each direction) were analyzed for 2042 sites (544 in the infarcted area, 488 in the border area, and 1010 in the normal area). The higher and lower voltages measured using each pair of opposing electrodes significantly differed (1.10 mV [0.43-2.56 mV] vs 0.69 mV [0.28-1.58 mV]; P,.0001), and the median variation was 0.28 mV (0.11-0.80 mV) (31.7% [16.0%-48.9%]). The voltage variation was maximized to 48.7% (37.7%-61.6%) (P,. 0001) on sites where the activation wavefront was perpendicular to the one bipolar direction and parallel to the other. A total of 594 of 719 (82.6%) sites with the voltage < 0.5 mV and 539 of 699 (77.1%) sites with the voltage >1.5 mV in NE stayed in the same voltage range as those in SE. However, only 348 of 624 (55.8%) sites with the voltage 0.5-1.5 mV in NE stayed in the same range as those in SE. Local ventricular abnormal activities (LAVAs) were detected in 592 of 2042 (29.0%) sites in total, frequently distributed in the border area. A total of 177 (29.9%) LAVAs were missed in one direction and 180 (30.4%) in the other. When 415 (70.1%) LAVAs detected in NE are defined as the reference, 235 of 415 (56.6%) matched with those detected in SE.CONCLUSION The bipolar voltage and distribution of LAVAs may differ significantly between diagonally orthogonal bipolar pairs at any given site.