Validation of the noncontact mapping system in the left atrium during permanent atrial fibrillation and sinus rhythm
Validation of the noncontact mapping system in the left atrium during permanent atrial fibrillation and sinus rhythm
复制标题
DOI：
10.1016/j.jacc.2006.04.069
复制
发表时间：
2006-08-01
影响因子：
24
通讯作者：
Schilling, Richard J.
中科院分区：
文献类型：
--
作者：
Earley, Mark J.;Abrams, Dominic J. R.;Schilling, Richard J.
目的本研究的目的是验证窦性心律和房颤（AF）期间左心房（LA）的非接触式标测（NCM）。背景了解AF的机制对于开发新型有效的治疗方法至关重要。非接触式标测记录全球电激活的同时，因此有可能阐明这些mechanism.Methods患者进行导管消融术的永久性房颤引导下的NCM。虚拟和接触单极电描记图同时记录在窦性心律和AF从网站跨越左心房和他们的形态，振幅和时间进行了比较。从阵列到endoorthography表面和电图振幅的距离的影响进行了analysed.Results共22例患者年龄52 - 9（平均值+/- SD）年进行了研究。在窦性心律期间，接触和虚拟心房电描记图之间的中位（范围）形态相关性和时间差分别为0.81（0.27至0.98）和4.2（0至18.3）ms。这些结果明显差于相应的远场个体心室电描记图; 0.91（0.53至1.0）和1.7（0至18.3）ms（p < 0.001）。对于距离阵列> 40 mm的内镜部位，相关性显著差于< 40 mm的部位：0.73（0.48至0.95）vs 0.87（0.27至0.98）（p < 0.001）。AF期间的相关性为0.72（0.24至0.98），随着与阵列距离的增加而恶化。在存在腺苷诱导的房室传导阻滞的情况下，相关性恶化0.67 +/- 0.16对0.79 +/- 0.11结论：非接触式标测可用于人左心房;然而，在距离阵列中心> 40分钟时，重建的电描记图的准确性较差，特别是在AF期间。如果LA的整个内表面不靠近阵列，则必须小心解释等电位图。
OBJECTIVES The aim of this study was to validate noncontact mapping (NCM) in the left atrium (LA) during sinus rhythm and atrial fibrillation (AF).BACKGROUND Understanding the mechanisms of AF is crucial to the development of novel and effective treatments. Noncontact mapping records global electrical activation simultaneously and therefore has the potential to elucidate these mechanisms.METHODS Patients underwent catheter ablation of permanent AF guided by NCM. Virtual and contact unipolar electrograms were recorded simultaneously during sinus rhythm and AF from sites spanning the LA and their morphology, amplitude, and timing were compared. The impact of distance from the array to the endocardial surface and electrogram amplitude were analyzed.RESULTS A total of 22 patients age 52 9 (mean +/- SD) years were studied. During sinus rhythm, the median (range) morphology correlation and timing difference between contact and virtual atrial electrograms were 0.81 (0.27 to 0.98) and 4.2 (0 to 18.3) ms, respectively. These results were significantly worse than the corresponding far field individual ventricular electrograms; 0.91 (0.53 to 1.0) and 1.7 (0 to 18.3) ms (p < 0.001). For endocardial sites > 40 mm from the array, the correlation was significantly worse than sites < 40 mm: 0.73 (0.48 to 0.95) versus 0.87 (0.27 to 0.98) (p < 0.001). The correlation during AF was 0.72 (0.24 to 0.98), which deteriorated with increasing distance from the array. In the presence of adenosine induced atrioventricular block the correlation deteriorated 0.67 +/- 0.16 versus 0.79 +/- 0.11 (p < 0.001).CONCLUSIONS Noncontact mapping can be performed in human LA; however, the accuracy of reconstructed electrograms is poor > 40 min from the center of the array, particularly during AF. Care must be taken interpreting isopotential maps if the entire endocardial surface of the LA is not close to the array.