Department of Cardiology, Westmead Hospital, PO Box 533, Wentworthville, Sydney, NSW 2145, Australia.
Europace. 2010 Jun;12(6):881-9. doi: 10.1093/europace/euq098. Epub 2010 Apr 1.
Identification of arrhythmogenic scar using non-contact (NC) sinus rhythm (SR) mapping is limited. Dynamic substrate mapping (DSM) overcomes these limitations but is less accurate than plunge needle electrode mapping. We developed a revised method for calculating DSM which was validated using detailed histological analysis and compared with conventional mapping modalities.
Mapping was performed in eight sheep, >9 weeks post-myocardial infarction. Twenty multielectrode needles were deployed at thoracotomy in the left ventricle within and surrounding scar, and located using Ensite. Simultaneous catheter, needle, and NC electrograms were recorded during SR and multisite pacing. Dynamic substrate mapping maps were calculated as the maximum local peak negative voltage (PNV). Absolute mean DSM (AMDSM) maps, based on peak-peak voltage (P-PV), were calculated to minimize local pacing effects and take into account anisotropic influence. Dynamic substrate mapping and AMDSM maps were normalized based on global maximum voltages attained. Histologically quantified scar and mapping criteria were compared using Spearman's correlation and receiver operator curves (area under the curve, AUC) using 50% scar cut-off. For unipolar mapping, needles had greatest sensitivity at identifying scar which was better for P-PV (AUC; needle = 0.90, catheter = 0.70, NC = 0.66) than for PNV (AUC; needle = 0.79, NC = 0.38). AMDSM (AUC = 0.75) had superior scar discrimination than either catheter (AUC; unipolar = 0.70, bipolar = 0.71) or DSM (AUC = 0.67). Absolute mean DSM accuracy was improved when valvular geometries were excluded (AUC = 0.77).
Absolute mean DSM was comparably accurate in identifying scarred myocardium as PNV needle mapping but was superior to conventional catheter and NC mapping.
使用非接触（NC）窦性心律（SR）标测识别致心律失常性瘢痕的效果有限。动态基质标测（DSM）克服了这些限制，但准确性不如 plunge 针电极标测。我们开发了一种改进的 DSM 计算方法，并用详细的组织学分析进行了验证，并与传统标测方式进行了比较。
在心肌梗死后 9 周以上的 8 只绵羊中进行了标测。在左心室的开胸手术中，在瘢痕内和周围部署了 20 个多电极针，并使用 Ensite 定位。在 SR 和多部位起搏期间记录同时的导管、针和 NC 心电图。动态基质标测图计算为最大局部峰值负电压（PNV）。基于峰峰值电压（P-PV）计算绝对平均 DSM（AMDSM）图，以最小化局部起搏的影响并考虑各向异性的影响。根据获得的全局最大电压对动态基质标测图和 AMDSM 图进行归一化。使用 Spearman 相关和接收器操作曲线（曲线下面积，AUC），通过 50%瘢痕截断值比较组织学量化的瘢痕和标测标准。对于单极标测，与 PNV（AUC；针=0.79，NC=0.38）相比，针在识别瘢痕方面具有更高的敏感性，而 P-PV（AUC；针=0.90，导管=0.70，NC=0.66）的敏感性更好。AMDSM（AUC=0.75）比单极导管（AUC；单极=0.70，双极=0.71）或 DSM（AUC=0.67）具有更好的瘢痕区分能力。排除瓣膜几何形状后，绝对平均 DSM 的准确性得到提高（AUC=0.77）。
绝对平均 DSM 识别瘢痕心肌的准确性与 PNV 针标测相当，但优于传统导管和 NC 标测。
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