Use of Novel Electrogram "Lumipoint" Algorithm to Detect Critical Isthmus and Abnormal Potentials for Ablation in Ventricular Tachycardia
Use of Novel Electrogram "Lumipoint" Algorithm to Detect Critical Isthmus and Abnormal Potentials for Ablation in Ventricular Tachycardia
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DOI：
10.1016/j.jacep.2019.01.016
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发表时间：
2019-04-01
影响因子：
7
通讯作者：
Sacher, Frederic
中科院分区：
文献类型：
--
作者：
Martin, Claire A.;Takigawa, Masateru;Sacher, Frederic
目的报道一种新的“Lumipoint”算法在室性心动过速(VT)消融中的应用。背景：自动标测系统有助于快速获取激活图。然而，它们可能会注释低电压区域的远场信号，而不是近场信号，这使得地图很难解释。Lumipoint算法分析完整的心电轨迹，因此在分析中包括近场信号。方法使用超高密度心律系统对22例缺血性心肌病患者和5例扩张型心肌病患者进行标测。结果在所有的左心室基底图中，将感兴趣的窗口改变为QRS后的相位自动识别出晚电位。在27张左室VT激活图中的25张中，一个感兴趣的最小空间窗口正确地识别了VT峡部，如手动注释的图、夹带和消融反应所示。在6幅地形图中，该算法识别了标准自动注记地图所不能识别的峡部。结论Lumipoint算法自动高亮显示具有特定特征或定时的电信号的区域。这可以识别晚期和分段的电位和显示不连续激活的区域，以及室速回路的峡部。这些特征可以在情况下增强人类对电信号的解释，特别是在电路位于具有低幅度近场信号的部分SCAR中的情况下，并且潜在地允许更有针对性的消融策略。(C)2019年，由美国心脏病学会基金会主办。
OBJECTIVES This study reports the use of a novel "Lumipoint" algorithm in ventricular tachycardia (VT) ablation.BACKGROUND Automatic mapping systems aid rapid acquisition of activation maps. However, they may annotate farfield rather than nearfield signal in low voltage areas, making maps difficult to interpret. The Lumipoint algorithm analyzes the complete electrogram tracing and therefore includes nearfield signals in its analysis.METHODS Twenty-two patients with ischemic cardiomyopathy and 5 with dilated cardiomyopathy underwent mapping using the ultra-high density Rhythmia system. Lumipoint algorithms were applied retrospectively.RESULTS In all left ventricular substrate maps, changing the window of interest to the post-QRS phase automatically identified late potentials. In 25 of 27 left ventricular VT activation maps, a minimum spatial window of interest correctly identified the VT isthmus as seen by the manually annotated map, entrainment, and response to ablation. In 6 maps, the algorithm identified the isthmus where the standard automatically annotated map did not.CONCLUSIONS The Lumipoint algorithm automatically highlights areas with electrograms having specific characteristics or timings. This can identify late and fractionated potentials and regions that exhibit discontinuous activation, as well as the isthmus of a VT circuit. These features may enhance human interpretation of the electrogram signals during a case, particularly where the circuit lies in partial scar with low amplitude nearfield signals and potentially allow a more targeted ablation strategy. (C) 2019 by the American College of Cardiology Foundation.