心房颤动导管消融后房性心动过速的标测：应用双心房激活模式有助于识别起源。
Mapping of atrial tachycardias after catheter ablation for atrial fibrillation: use of bi-atrial activation patterns to facilitate recognition of origin.
机构信息
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
出版信息
Heart Rhythm. 2010 May;7(5):664-72. doi: 10.1016/j.hrthm.2010.01.009. Epub 2010 Jan 11.
BACKGROUND
Mapping and ablation of atrial tachycardias (ATs) secondary to catheter ablation of atrial fibrillation (AF) is often challenging due to the complex atrial substrate, different AT mechanisms, and potential origin not only in the left atrium (LA) but also from the right atrium (RA) and the adjacent thoracic veins.
OBJECTIVE
This study sought to develop an algorithm to facilitate localization of successful ablation regions based on limited activation data from simultaneous RA and coronary sinus (CS) recordings acquired from a single 20-pole catheter.
METHODS
Simultaneous lateral RA and CS atrial activation patterns (AAPs) from a 20-electrode catheter were analyzed for 155 successfully ablated ATs in 133 patients (age 58 +/- 9.6 years; 104 male [78.2%]) with prior ablation for AF. The first 125 ATs in 109 patients were analyzed retrospectively to define specific AAPs related to the location of critical AT sites as defined by effective ablation in 1 of 3 atrial regions. A classification algorithm was developed and tested retrospectively in a second blinded evaluation of the 125 previously analyzed ATs. The accuracy of the algorithm was then prospectively tested in 30 ATs in 24 patients.
RESULTS
Seven different lateral RA-CS activation patterns were identified as indicating AT origin from the left lateral atrium, septum, roof, or RA, with the pattern for some regions dependent on whether conduction block was present in common atrial flutter isthmuses. The algorithm derived identified the region of effective ablation with a sensitivity of 93%, a specificity of 97%, and a positive predictive value of 80% in the blinded analysis. In the prospective series, overall accuracy was 96%.
CONCLUSION
Simultaneous assessment of RA and CS activation patterns from a single RA catheter suggests the likely region of origin of ATs that emerge after AF ablation, and may therefore facilitate ablation of these complex arrhythmias.
背景
由于心房基质复杂、不同的心动过速机制以及潜在起源不仅在左心房（LA），还可能在右心房（RA）和相邻的胸静脉，因此对继发于心房颤动（AF）导管消融的房性心动过速（ATs）进行标测和消融常常具有挑战性。
目的
本研究旨在开发一种算法，以根据从单个 20 电极导管采集的同时 RA 和冠状窦（CS）记录中的有限激活数据，方便确定消融成功区域的定位。
方法
分析了来自 20 电极导管的同时 RA 和 CS 心房激活模式（AAPs），这些 AAPs 来自 133 例（年龄 58 ± 9.6 岁；104 例男性[78.2%]）先前因 AF 消融而进行消融的患者的 155 例成功消融的 ATs。在回顾性分析了 109 例患者的前 125 例 ATs 后，定义了与通过在 3 个心房区域中的 1 个区域的有效消融定义的关键 AT 部位的位置相关的特定 AAPs。开发了一种分类算法，并在对之前分析的 125 例 ATs 的第二次盲法评估中进行了回顾性测试。然后，前瞻性地在 24 例患者的 30 例 ATs 中测试了该算法的准确性。
结果
确定了 7 种不同的 RA-CS 激活模式，这些模式表明 AT 起源于左外侧心房、间隔、房顶或 RA，其中一些区域的模式取决于是否存在共同的心房扑动峡部传导阻滞。在盲法分析中，该算法识别有效消融区域的灵敏度为 93%、特异性为 97%和阳性预测值为 80%。在前瞻性系列中，总准确率为 96%。
结论
从单个 RA 导管同时评估 RA 和 CS 激活模式可提示 AF 消融后出现的 AT 的可能起源部位，从而可能有助于消融这些复杂的心律失常。
Zotero 插件