心内膜单极电压标测识别心律失常性右室心肌病/发育不良的心外膜基质。
Endocardial unipolar voltage mapping to identify epicardial substrate in arrhythmogenic right ventricular cardiomyopathy/dysplasia.
机构信息
Section of Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
出版信息
Heart Rhythm. 2011 Jan;8(1):76-83. doi: 10.1016/j.hrthm.2010.09.088. Epub 2010 Nov 27.
BACKGROUND
The risk and success of epicardial substrate ablation for ventricular tachycardia (VT) support the value of techniques identifying the epicardial substrate with endocardial mapping.
OBJECTIVE
The purpose of this study was to test the hypothesis that endocardial unipolar voltage mapping in patients with right ventricular (RV) VT and preserved endocardial bipolar voltage abnormalities might identify the extent of epicardial bipolar voltage abnormality.
METHODS
Using a cutoff of < 5.5 mV for normal endocardial unipolar voltage derived from 8 control patients without structural heart disease, 10 patients with known ARVC/D (group 1, retrospective) and 13 patients with RV VT (group 2, prospective) with modest or no endocardial bipolar voltage abnormalities underwent detailed endocardial and epicardial mapping.
RESULTS
The area of epicardial unipolar voltage abnormality in all 10 group 1 patients with ARVC/D (62 ± 21 cm²) and in 9 of the 13 group 2 patients (8 with criteria for ARVC/D) (53 ± 21 cm²) was on average three times more extensive than the endocardial bipolar abnormality and correlated (r = 0.63, P <.05 and r = 0.81, P <.008, respectively) with the larger area epicardial bipolar abnormality with respect to size (group 1: 82 ± 22 cm²; group 2: 68 ± 41 cm²) and location. In the remaining 4 group 2 patients and 3 additional reference patients without structural heart disease, endocardial bipolar, endocardial unipolar, and, as predicted, epicardial bipolar voltage all were normal.
CONCLUSION
Endocardial unipolar mapping with cutoff of 5.5 mV identifies more extensive areas of epicardial bipolar signal abnormalities in patients with ARVC/D and limited endocardial VT substrate.
背景
心外膜基质消融治疗室性心动过速（VT）的风险和成功率支持使用技术识别心内膜标测下心外膜基质的价值。
目的
本研究旨在检验以下假设，即右心室（RV）VT 且存在保存的心内膜双极电压异常的患者中心内膜单极电压标测可能识别心外膜双极电压异常的范围。
方法
使用 8 例无结构性心脏病的对照患者中正常心内膜单极电压的截止值<5.5 mV（无 ARVC/D），对 10 例已知 ARVC/D（组 1，回顾性）和 13 例 RV VT（组 2，前瞻性）患者进行详细的心内膜和心外膜标测，这些患者存在适度或无明显的心内膜双极电压异常。
结果
在所有 10 例 ARVC/D 患者（组 1）（62 ± 21 cm²）和 13 例 RV VT 患者中的 9 例（9 例符合 ARVC/D 标准）（组 2）（53 ± 21 cm²）中，心外膜单极电压异常的面积平均比心内膜双极异常大 3 倍，与较大面积的（组 1：82 ± 22 cm²；组 2：68 ± 41 cm²）和位置相关。在其余 4 例组 2 患者和另外 3 例无结构性心脏病的参考患者中，心内膜双极、心内膜单极和预测的，心外膜双极电压均正常。
结论
使用 5.5 mV 的截止值进行心内膜单极标测可识别 ARVC/D 和有限的心内膜 VT 基质患者中更大面积的心外膜双极信号异常。
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