Local unipolar and bipolar electrogram criteria for evaluating the transmurality of atrial ablation lesions at different catheter orientations relative to the endocardial surface
Local unipolar and bipolar electrogram criteria for evaluating the transmurality of atrial ablation lesions at different catheter orientations relative to the endocardial surface
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DOI：
10.1016/j.hrthm.2010.06.014
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发表时间：
2010-09-01
期刊：
影响因子：
5.5
通讯作者：
Iesaka, Yoshito
中科院分区：
文献类型：
--
作者：
Otomo, Kiyoshi;Uno, Kikuya;Iesaka, Yoshito
背景在心房消融过程中识别跨壁病变（TLs）的产生是很重要的。目的：本研究的目的是表征在不同的导管定向下从TL记录的局部单极电图（ue）和双极电图（BEs）。方法13头猪，在记录UE和BE时，在心房平滑心肌区进行125次逐点消融。根据左心房图，将导管定位调整为与心内膜表面垂直或倾斜（非平行，80个位点）或平行（75个位点）。结果显微镜检查发现54个位点有TLs， 71个位点无TLs。无论导管定向如何，从TLs记录的远端UE始终显示出负偏转的消除，而从非TLs记录的UE则没有。从非平行导管定向的tl记录的BE一致显示出正偏转的消除，而平行导管定向显示出两种不同模式中的一种：(1)显示QRS模式预消融部位的R波主要衰减（>= 75%）或(2)显示RSR模式预消融部位的R波完全消除。不同导管取向下BE形态变化模式的异质性是由于近端UE对BE的贡献程度不同。结论：UE和BE标准可成功区分TLs和非TLs。在不同的导管定位下，识别TL形成应采用不同的BE标准。
BACKGROUND Recognition of the creation of transmural lesions (TLs) during atrial ablation procedures is important.OBJECTIVE The purpose of this study was to characterize local unipolar electrograms (UEs) and bipolar electrograms (BEs) recorded from a TL at different catheter orientations.METHODS In 13 porcines, 125 point-by-point ablations were performed in the smooth myocardial areas of the atria during recording of UE and BE. Catheter orientation was adjusted to be perpendicular or oblique (nonparallel; 80 sites) or parallel (75 sites) to the endocardial surface based on left atriograms.RESULTS Microscopic examination revealed TLs in 54 sites and non-TLs in 71 sites. Irrespective of catheter orientation, the distal UE recorded from TLs consistently exhibited elimination of a negative deflection, whereas that from non-TLs did not. BE recorded from TLs with nonparallel catheter orientation consistently exhibited elimination of a positive deflection, whereas that with parallel catheter orientation exhibited one of two different pat-terns: (1) predominant attenuation (>= 75%) of the R wave at sites exhibiting QRS pattern preablation or (2) complete elimination of the R' wave at sites exhibiting RSR' pattern preablation. The heterogeneity of the patterns of morphologic change in BE at the different catheter orientations was due to the different degree of contribution of the proximal UE to BE.CONCLUSION: UE and BE criteria successfully differentiated TLs from non-TLs. Different BE criteria should be applied for recognizing TL formation in different catheter orientations.