Bipolar Voltage Mapping for the Evaluation of Atrial Substrate: Can We Overcome the Challenge of Directionality?
Bipolar Voltage Mapping for the Evaluation of Atrial Substrate: Can We Overcome the Challenge of Directionality?
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DOI：
10.4022/jafib.2116
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发表时间：
2019-02-01
影响因子：
--
通讯作者：
Node, Koichi
中科院分区：
文献类型：
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作者：
Yamaguchi, Takanori;Fukui, Akira;Node, Koichi
心房纤维化与心房颤动（AF）的关系已被证实。通过双极电压标测估计的靶向纤维化组织的患者特异性基质消融已成为肺静脉隔离之外额外基质修改的替代策略。低电压电描记图的主要机制被认为是心房纤维化，然而，组织学纤维化和低电压区之间没有直接相关性。此外，低电压区的定义仍有争议，双极电压幅度取决于多个变量，包括电极相对于波前方向的取向、电极长度、电极间间距和组织接触。本文的目的是回顾电压标测的作用和局限性，并分享我们新发布的网格图案设计的标测导管的初步经验，使电压标测更可靠地指导患者特定的AF消融。
The relationship between atrial fibrosis and atrial fibrillation (AF) has been proven. Patient specific substrate ablation targeting fibrotic tissue estimated by bipolar voltage mapping has emerged as an alternative strategy for additional substrate modification beyond pulmonary vein isolation. The primary mechanism of a low-voltage electrogram has been suggested to be atrial fibrosis, however, no direct correlation between histological fibrosis and low-voltage zone has been confirmed. Furthermore, the definition of low-voltage zone is still controversial, and bipolar voltage amplitudes depend on multiple variables including electrodes orientation relative to direction of wavefront, electrode length, interelectrode spacing, and tissue contact. The aim of this article is to review the role and limitation of voltage mapping, and to share our initial experience of a newly released grid-pattern designed mapping catheter to make the voltage mapping more reliable to guide patient specific AF ablation.