Lang Christopher C E, Gugliotta Filippo, Santinelli Vincenzo, Mesas Cézar, Tomita Takeshi, Vicedomini Gabriele, Augello Giuseppe, Gulletta Simone, Mazzone Patrizio, De Cobelli Francesco, Del Maschio Alessandro, Pappone Carlo
Division of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Milan, Italy.
Heart Rhythm. 2006 Feb;3(2):171-8. doi: 10.1016/j.hrthm.2005.10.017.
Circumferential pulmonary vein ablation (CPVA) is an effective treatment for atrial fibrillation (AF). Accurate left atrial (LA) mapping is essential for creating lesions at the LA-pulmonary vein (PV) junction, avoiding PV stenosis.
The purpose of this study was to establish whether endocardial impedance varies within the LA and PVs and whether it is a useful tool for mapping and ablation.
Pilot Phase: Three-dimensional LA maps were created using CARTO. Impedance (Z) was measured using a radiofrequency generator at multiple points in the LA, PV ostia (PVO), and deep PVs in 79 patients undergoing their first AF ablation (group 1) and 29 patients undergoing repeat CPVA (group 2). Prospective Phase: In an additional 20 patients, using pilot phase data, one operator defined catheter tip location as either LA or PVO based on CARTO and fluoroscopy. A second operator blinded to CARTO simultaneously did the same based on impedance at 15 +/- 4 points per patient.
Group 1: Z(LA) was 99.4 +/- 9.0 omega. Z(PVO) was higher (109.2 +/- 8.5 omega), rising further as the catheter advanced into deep PV (137 omega +/- 18). Z(PVO) differed from Z(LA) by 9 +/- 4 omega. Group 2 had a lower Z(LA) and Z(PVO) compared with group 1 (P <.05). Impedance monitoring differentiated between LA and PVO, with 91% specificity and sensitivity, 96% positive predictive value, and 81% negative predictive value. At 3-month follow-up, no patients had evidence of PV stenosis on magnetic resonance imaging.
Impedance mapping reliably identifies the LA-PV transitional zone, facilitating AF ablation, and its use is associated with a low incidence of PV stenosis.
环肺静脉消融术（CPVA）是治疗心房颤动（AF）的一种有效方法。准确的左心房（LA）标测对于在左心房-肺静脉（PV）交界处制造损伤、避免肺静脉狭窄至关重要。
本研究旨在确定心内膜阻抗在左心房和肺静脉内是否变化，以及它是否是一种用于标测和消融的有用工具。
试点阶段：使用CARTO创建三维左心房图。在79例首次接受房颤消融的患者（第1组）和29例接受重复CPVA的患者（第2组）中，使用射频发生器在左心房、肺静脉口（PVO）和肺静脉深部的多个点测量阻抗（Z）。前瞻性阶段：在另外20例患者中，根据试点阶段的数据，一名操作者基于CARTO和荧光镜检查将导管尖端位置定义为左心房或肺静脉口。另一名对CARTO不知情的操作者同时根据每位患者15±4个点的阻抗进行同样的定义。
第1组：Z（左心房）为99.4±9.0Ω。Z（肺静脉口）更高（109.2±8.5Ω），随着导管深入肺静脉，Z值进一步升高（137Ω±18）。Z（肺静脉口）与Z（左心房）相差9±4Ω。与第1组相比，第2组Z（左心房）和Z（肺静脉口）较低（P<.05）。阻抗监测能够区分左心房和肺静脉口，特异性为91%，敏感性为91%，阳性预测值为96%，阴性预测值为81%。在3个月的随访中，磁共振成像显示没有患者有肺静脉狭窄的证据。
阻抗标测能够可靠地识别左心房-肺静脉过渡区，有助于房颤消融，并且其应用与肺静脉狭窄的低发生率相关。
