Impact of Electrode Type on Mapping of Scar-Related VT
Impact of Electrode Type on Mapping of Scar-Related VT
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DOI：
10.1111/jce.12761
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发表时间：
2015-11-01
影响因子：
2.7
通讯作者：
Jais, Pierre
中科院分区：
文献类型：
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作者：
Berte, Benjamin;Relan, Jatin;Jais, Pierre
瘢痕相关VT标测背景基于基质的VT消融主要基于消融导管获得的标测。我们假设多极标测导管更有效地识别瘢痕和局部异常心室活动（LAVA）。方法和结果第1阶段：在绵羊梗死模型（梗死后2个月）中，使用Navistar（NAV）与PentaRay（PR）导管（Biosense韦伯斯特）进行基质标测和LAVA标记（CARTO（（R））3）。第2阶段：来自单中心的连续性VT消融患者接受了NAV与PR标测。点对被定义为PR和NAV点位于3 mm的3D距离内。一致性被定义为一对中的两个点被手动标记为正常或LAVA。纳入了4只绵羊（4岁，50 4.8 kg）和9例患者（53 ± 14岁，8例雄性，6例缺血性心肌病）。PR组瘢痕内的标测密度高于NAV组（3.2 vs. 0.7点/cm（2），P = 0.001），双极瘢痕面积较大（68 +/- 55 cm（2）vs. 58 +/- 48 cm（2），P = 0.001）。总共分析了818个点对。使用PR时，远场电压较小（PR vs. NAV;双极：1.43 +/- 1.84 mV vs. 1.64 +/- 2.04 mV，P = 0.001;单极：4.28 +/- 3.02 mV vs. 4.59 +/- 3.67 mV，P < 0.001）。PR组也检测到更多LAVA（PR vs. NAV; 126 +/- 113 vs. 36 +/- 29，P = 0.001）。当协议LAVA达到（总体：72%;两个LAVA，40%;都正常，82%）更高的LAVA电压记录PR（0.48 +/- 0.33 mV与0.31 +/- 0.21 mV，P = 0.0001）。PR和NAV之间的一致性较低。
Mapping of Scar-Related VTBackgroundSubstrate-based VT ablation is mostly based on maps acquired with ablation catheters. We hypothesized that multipolar mapping catheters are more effective for identification of scar and local abnormal ventricular activity (LAVA).Methods and resultsPhase1: In a sheep infarction model (2 months postinfarction), substrate mapping and LAVA tagging (CARTO((R))3) was performed, using a Navistar (NAV) versus a PentaRay (PR) catheter (Biosense Webster). Phase2: Consecutive VT ablation patients from a single center underwent NAV versus PR mapping. Point pairs were defined as a PR and a NAV point located within a 3D-distance of 3 mm. Agreement was defined as both points in a pair being manually tagged as normal or LAVA. Four sheep (4 years, 50 4.8 kg) and 9 patients were included (53 +/- 14 years, 8 male, 6 ischemic cardiomyopathy). Mapping density was higher within the scar with PR versus NAV (3.2 vs. 0.7 points/cm(2), P = 0.001) with larger bipolar scar area (68 +/- 55 cm(2) vs. 58 +/- 48 cm(2), P = 0.001). In total, 818 point pairs were analyzed. Using PR, far-field voltages were smaller (PR vs. NAV; bipolar: 1.43 +/- 1.84 mV vs. 1.64 +/- 2.04 mV, P = 0.001; unipolar; 4.28 +/- 3.02 mV vs. 4.59 +/- 3.67 mV, P < 0.001). More LAVA were also detected with PR (PR vs. NAV; 126 +/- 113 vs. 36 +/- 29, P = 0.001). When agreement on LAVA was reached (overall: 72%; both LAVA, 40%; both normal, 82%) higher LAVA voltages were recorded on PR (0.48 +/- 0.33 mV vs. 0.31 +/- 0.21 mV, P = 0.0001).ConclusionMultipolar mapping catheters with small electrodes provide more accurate and higher density maps, with a higher sensitivity to near-field signals. Agreement between PR and NAV is low.