Jesel Laurence, Sacher Frédéric, Komatsu Yuki, Daly Matthew, Zellerhoff Stephan, Lim Han S, Derval Nicolas, Denis Arnaud, Ambri Wislane, Ramoul Khaled, Aurillac Valérie, Hocini Mélèze, Haïssaguerre Michel, Jaïs Pierre
From the Department of Cardiac Electrophysiology, Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, Bordeaux, France.
Circ Arrhythm Electrophysiol. 2014 Dec;7(6):1168-73. doi: 10.1161/CIRCEP.113.001219. Epub 2014 Sep 25.
The optimal contact force (CF) for ventricular mapping and ablation remains unvalidated. We assessed CF in different endocardial and epicardial regions during ventricular tachycardia substrate mapping using a CF-sensing catheter (Smartouch; Biosense-Webster) and compared the transseptal versus retroaortic approach.
In total, 8979 mapping points with CF, and force vector orientation (VO) were recorded in 21 patients, comprising 13 epicardial, 12 left ventricular (6 transseptal and 6 retroaortic approach), and 12 right ventricular endocardial maps. VO was defined as adequate when the vector was directed toward the myocardium. During epicardial mapping, 46% of the points showed an adequate VO and a median CF of 8 (4-13) g, however, with significant differences among the 8 regions. When VO was inadequate, median CF was higher at 16 (10-24) g (P<0.0001). During left ventricular and right ventricular endocardial mapping, 94% of VO were adequate. Median CF of adequate VO was higher in the left ventricular and right ventricular endocardium than in the epicardium (15 [8-25] and 13 [7-22] g versus 8 [4-13] g, respectively; both P<0.001). Global median left ventricular CF with transseptal approach was not statistically different from retroaortic approach, but CF in the apicoinferior and apicoseptal regions was higher with transseptal approach (P<0.001).
Ventricular mapping demonstrates important regional variations in CF, but in general, CF is higher endocardially than epicardially where poor catheter orientation is associated with higher CF. A transseptal approach may lead to improved contact particularly in the apicoseptal and inferior regions.
心室标测和消融的最佳接触力（CF）仍未得到验证。我们使用CF感知导管（Smartouch；Biosense-Webster）在室性心动过速基质标测期间评估了不同心内膜和心外膜区域的CF，并比较了经房间隔与经主动脉后途径。
共记录了21例患者的8979个具有CF和力向量方向（VO）的标测点，包括13个心外膜、12个左心室（6个经房间隔和6个经主动脉后途径）以及12个右心室心内膜图。当向量指向心肌时，VO被定义为合适。在心外膜标测期间，46%的点显示VO合适，CF中位数为8（4-13）g，然而，8个区域之间存在显著差异。当VO不合适时，CF中位数更高，为16（10-24）g（P<0.0001）。在左心室和右心室心内膜标测期间，94%的VO合适。合适VO的CF中位数在左心室和右心室心内膜高于心外膜（分别为15[8-25]和13[7-22]g对8[4-13]g；均P<0.001）。经房间隔途径的左心室整体CF中位数与经主动脉后途径无统计学差异，但经房间隔途径在心底和心尖间隔区域的CF更高（P<0.001）。
心室标测显示CF存在重要的区域差异，但一般而言，心内膜的CF高于心外膜，导管方向不佳时CF更高。经房间隔途径可能会改善接触，特别是在心尖间隔和心底区域。
