From the Centre Hospitalier Princesse Grace, Monaco.
Circ Arrhythm Electrophysiol. 2017 Jan;10(1). doi: 10.1161/CIRCEP.116.004510.
Accurate activation mapping of reentrant scar-related atrial tachycardias (AT) allows efficient radiofrequency ablation by targeting the critical isthmus (CI). We aimed to assess the electrophysiological properties of CI channels during mapping with the IntellaMap Orion basket and the Rhythmia system.
We prospectively studied 33 AT (post- atrial fibrillation ablation or surgical mitral valve repair). The noise of bipolar electrogram (EGM) was systematically measured at 10 prespecified sites, as well as on a standard catheter and on the surface ECG. Bipolar EGM of CI regions were analyzed for amplitude, duration, and conduction velocity. The isthmus region to be targeted was chosen based solely on propagation. For each AT, 25 684±14 276 EGMs were automatically annotated. Noise of the Orion EGM was 0.011±0.004 mV, lower than that of a standard catheter (0.016±0.019) and surface ECG (0.02±0.01; P<0.05). For reentrant AT, within the CI, bipolar EGM amplitude (0.08±0.11 mV) and conduction velocity (0.27±0.19 m/s) were lower than those orthodromically before (0.62±0.93 mV; 1±0.49 m/s) and after (0.80±1.59 mV; 1±0.73 m/s) the isthmus (P<0.001 for all). In 97% of AT, ablation at the CI resulted in AT termination. No complications occurred.
This new automated ultrahigh resolution mapping system produces low noise and allows accurate diagnosis of AT circuits. CI on reentrant scar-related AT showed much lower EGM amplitude with a significantly slower conduction velocity than the surrounding parts of the circuit. Ablation of the areas of slow conduction resulted in a high acute success.
精确的折返性瘢痕相关房性心动过速（AT）的激活图有助于通过靶向关键峡部（CI）来实现高效的射频消融。我们旨在评估使用 IntellaMap Orion 篮状和 Rhythmia 系统进行标测时 CI 通道的电生理特性。
我们前瞻性地研究了 33 例 AT（心房颤动消融后或二尖瓣手术修复后）。在 10 个预设部位、标准导管和体表心电图上系统地测量了双极电图（EGM）的噪声。对 CI 区域的双极 EGM 进行了幅度、持续时间和传导速度的分析。目标峡部区域的选择仅基于传播。对于每例 AT，自动标注了 25684±14276 个 EGM。Orion EGM 的噪声为 0.011±0.004 mV，低于标准导管（0.016±0.019 mV）和体表心电图（0.02±0.01 mV；P<0.05）。对于折返性 AT，在 CI 内，双极 EGM 幅度（0.08±0.11 mV）和传导速度（0.27±0.19 m/s）低于峡部之前（0.62±0.93 mV；1±0.49 m/s）和之后（0.80±1.59 mV；1±0.73 m/s）（所有 P<0.001）。在 97%的 AT 中，CI 处的消融导致 AT 终止。无并发症发生。
这种新的自动超高分辨率标测系统产生的噪声较低，可准确诊断 AT 环。折返性瘢痕相关 AT 的 CI 显示出比环路周围部分低得多的 EGM 幅度和明显较慢的传导速度。慢传导区域的消融导致急性成功率高。
