从猪胃黏膜表面进行胃慢波传播的高分辨率电标测。
High-resolution electrical mapping of porcine gastric slow-wave propagation from the mucosal surface.
作者信息
Angeli T R, Du P, Paskaranandavadivel N, Sathar S, Hall A, Asirvatham S J, Farrugia G, Windsor J A, Cheng L K, O'Grady G
机构信息
Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
Department of Surgery, University of Auckland, Auckland, New Zealand.
出版信息
Neurogastroenterol Motil. 2017 May;29(5). doi: 10.1111/nmo.13010. Epub 2016 Dec 29.
BACKGROUND
Gastric motility is coordinated by bioelectrical slow waves, and gastric dysrhythmias are reported in motility disorders. High-resolution (HR) mapping has advanced the accurate assessment of gastric dysrhythmias, offering promise as a diagnostic technique. However, HR mapping has been restricted to invasive surgical serosal access. This study investigates the feasibility of HR mapping from the gastric mucosal surface.
METHODS
Experiments were conducted in vivo in 14 weaner pigs. Reference serosal recordings were performed with flexible-printed-circuit (FPC) arrays (128-192 electrodes). Mucosal recordings were performed by two methods: (i) FPC array aligned directly opposite the serosal array, and (ii) cardiac mapping catheter modified for gastric mucosal recordings. Slow-wave propagation and morphology characteristics were quantified and compared between simultaneous serosal and mucosal recordings.
KEY RESULTS
Slow-wave activity was consistently recorded from the mucosal surface from both electrode arrays. Mucosally recorded slow-wave propagation was consistent with reference serosal activation pattern, frequency (P≥.3), and velocity (P≥.4). However, mucosally recorded slow-wave morphology exhibited reduced amplitude (65-72% reduced, P<.001) and wider downstroke width (18-31% wider, P≤.02), compared to serosal data. Dysrhythmias were successfully mapped and classified from the mucosal surface, accorded with serosal data, and were consistent with known dysrhythmic mechanisms in the porcine model.
CONCLUSIONS & INFERENCES: High-resolution gastric electrical mapping was achieved from the mucosal surface, and demonstrated consistent propagation characteristics with serosal data. However, mucosal signal morphology was attenuated, demonstrating necessity for optimized electrode designs and analytical algorithms. This study demonstrates feasibility of endoscopic HR mapping, providing a foundation for advancement of minimally invasive spatiotemporal gastric mapping as a clinical and scientific tool.
背景
胃动力由生物电慢波协调，且在动力障碍中报道有胃节律紊乱。高分辨率（HR）标测推进了对胃节律紊乱的准确评估，有望成为一种诊断技术。然而，HR标测一直局限于侵入性手术的浆膜面接入。本研究探讨从胃黏膜表面进行HR标测的可行性。
方法
在14只断奶仔猪体内进行实验。使用柔性印刷电路（FPC）阵列（128 - 192个电极）进行参考浆膜记录。通过两种方法进行黏膜记录：（i）FPC阵列与浆膜阵列直接相对排列，以及（ii）经改良用于胃黏膜记录的心脏标测导管。对同步的浆膜和黏膜记录之间的慢波传播和形态特征进行量化和比较。
主要结果
从两个电极阵列的黏膜表面均持续记录到慢波活动。黏膜记录的慢波传播与参考浆膜激活模式、频率（P≥0.3）和速度（P≥0.4）一致。然而，与浆膜数据相比，黏膜记录的慢波形态表现为振幅降低（降低65 - 72%，P<0.001）和降支宽度增宽（增宽18 - 31%，P≤0.02）。从黏膜表面成功标测并分类了节律紊乱，与浆膜数据一致，且与猪模型中已知的节律紊乱机制相符。
结论与推论
从黏膜表面实现了高分辨率胃电标测，并证明与浆膜数据具有一致的传播特征。然而，黏膜信号形态减弱，表明需要优化电极设计和分析算法。本研究证明了内镜HR标测的可行性，为将微创时空胃标测发展成为临床和科研工具奠定了基础。
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