Utility of ripple mapping for identification of slow conduction channels during ventricular tachycardia ablation in the setting of arrhythmogenic right ventricular cardiomyopathy.
Utility of ripple mapping for identification of slow conduction channels during ventricular tachycardia ablation in the setting of arrhythmogenic right ventricular cardiomyopathy.
复制标题
在致心律失常性右心室心肌病的情况下，在室性心动过速消融过程中使用波纹映射来识别慢传导通道。
DOI：
10.1111/jce.13819
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发表时间：
2019
影响因子：
2.7
通讯作者：
Naz
中科院分区：
文献类型：
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作者：
Xie,Shuanglun;Kubala,Maciej;Liang,JacksonJ;Yang,Jiandu;Desjardins,Benoit;Santangeli,Pasquale;vanderGeest,RobJ;Schaller,Robert;Riley,Michael;Supple,Gregory;Frankel,DavidS;Callans,David;Pac,EricaZado;Marchlinski,Francis;Naz
Ripple标测可显示双极电图的每一个偏转，并使梗死后心室瘢痕内的传导通道（RMCC）可视化，以指导室性心动过速（VT）消融。尚未描述RMCC识别在致心律失常性右心室心肌病（ARVC）背景下促进VT消融的效用。我们试图（a）通过涟漪标测识别心内膜/心外膜瘢痕中的慢传导通道和（B）回顾性分析RMCC的消除是否与改善的无VT生存率相关，方法使用CARTO 3系统在窦性心律或心室起搏下收集高密度右心室内膜和心外膜电描记图，并对RMCC进行审查。使用标准化晚期钆增强（LGE）磁共振成像（MRI）信号强度（SI）z-scores.ResultsA队列的20例ARVC患者同时进行高密度右心室内膜和心外膜电图标测，确定心外膜的低电压区和异常心肌（年龄44 ± 13岁）。心外膜瘢痕（定义为双极电压小于1.0 mV）占心外膜总表面积的47.6%（四分位距[IQR]，30.9 - 63.7），大于心内膜瘢痕（定义为双极电压小于1.5 mV）占心内膜面积的11.2%（IQR，4.2 ± 17.8）（P< 0.01）。每例患者的RMCC中位数为1.5，定义为瘢痕内连续的晚期激动走廊（IQR，1 - 3），其中大部分为心外膜。RMCC消融的中位比率为1（IQR，0.6 - 1）。在中位44个月的随访期间（IQR，11 - 49），RMCC消融率与无复发性室性心动过速相关（风险比，0.01;P= 0.049）。在9例充分MRI，73%的RMCC被定位在LGE区域，24%的LGE区域附近，和3%的区域没有LGE.Conclusionslow传导通道内内膜或心外膜ARVC疤痕划定清楚的涟漪映射，并对应于关键峡部网站在夹带。完全消除RMCC与无VT相关。
BackgroundRipple mapping displays every deflection of a bipolar electrogram and enables the visualization of conduction channels (RMCC) within postinfarction ventricular scar to guide ventricular tachycardia (VT) ablation. The utility of RMCC identification for facilitation of VT ablation in the setting of arrhythmogenic right ventricular cardiomyopathy (ARVC) has not been described.ObjectiveWe sought to (a) identify the slow conduction channels in the endocardial/epicardial scar by ripple mapping and (b) retrospectively analyze whether the elimination of RMCC is associated with improved VT‐free survival, in ARVC patients.MethodsHigh‐density right ventricular endocardial and epicardial electrograms were collected using the CARTO 3 system in sinus rhythm or ventricular pacing and reviewed for RMCC. Low‐voltage zones and abnormal myocardium in the epicardium were identified by using standardized late‐gadolinium–enhanced (LGE) magnetic resonance imaging (MRI) signal intensity (SI)z‐scores.ResultsA cohort of 20 ARVC patients that had undergone simultaneous high‐density right ventricular endocardial and epicardial electrogram mapping was identified (age 44 ± 13 years). Epicardial scar, defined as bipolar voltage less than 1.0 mV, occupied 47.6% (interquartile range [IQR], 30.9‐63.7) of the total epicardial surface area and was larger than endocardial scar, defined as bipolar voltage less than 1.5 mV, which occupied 11.2% (IQR, 4.2 ± 17.8) of the endocardium (P< 0.01). A median 1.5 RMCC, defined as continuous corridors of sequential late activation within scar, were identified per patient (IQR, 1‐3), most of which were epicardial. The median ratio of RMCC ablated was 1 (IQR, 0.6‐1). During a median follow‐up of 44 months (IQR, 11‐49), the ratio of RMCC ablated was associated with freedom from recurrent VT (hazard ratio, 0.01;P= 0.049). Among nine patients with adequate MRI, 73% of RMCC were localized in LGE regions, 24% were adjacent to an area with LGE, and 3% were in regions without LGE.ConclusionSlow conduction channels within endocardial or epicardial ARVC scar were delineated clearly by ripple mapping and corresponded to critical isthmus sites during entrainment. Complete elimination of RMCC was associated with freedom from VT.