Luther Vishal, Sikkel Markus, Bennett Nathan, Guerrero Fernando, Leong Kevin, Qureshi Norman, Ng Fu Siong, Hayat Sajad A, Sohaib S M Afzal, Malcolme-Lawes Louisa, Lim Elaine, Wright Ian, Koa-Wing Michael, Lefroy David C, Linton Nick W F, Whinnett Zachary, Kanagaratnam Prapa, Davies D Wyn, Peters Nicholas S, Lim Phang Boon
From the Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (V.L., M.S., K.L., N.Q., F.S.N., S.A.H., S.M.A.S., L.M.-L., E.L., I.W., M.K.-W., D.C.L., N.W.F.L., Z.W., P.K., D.W.D., N.S.P., P.B.L.); and Boston Scientific Ltd, Marlborough, MA (N.B., F.G.).
Circ Arrhythm Electrophysiol. 2017 Apr;10(4). doi: 10.1161/CIRCEP.116.004724.
The activation pattern of localized reentry (LR) in atrial tachycardia remains incompletely understood. We used the ultra-high density Rhythmia mapping system to study activation patterns in LR.
LR was suggested by small rotatory activations (carousels) containing the full spectrum of the color-coded map. Twenty-three left-sided atrial tachycardias were mapped in 15 patients (age: 64±11 years). 16 253±9192 points were displayed per map, collected over 26±14 minutes. A total of 50 carousels were identified (median 2; quartiles 1-3 per map), although this represented LR in only n=7 out of 50 (14%): here, rotation occurred around a small area of scar (<0.03 mV; 12±6 mm diameter). In LR, electrograms along the carousel encompassed the full tachycardia cycle length, and surrounding activation moved away from the carousel in all directions. Ablating fractionated electrograms (117±18 ms; 44±13% of tachycardia cycle length) within the carousel interrupted the tachycardia in every LR case. All remaining carousels were pseudo-reentrant (n=43/50 [86%]) occurring in areas of wavefront collision (n=21; median 0.5; quartiles 0-2 per map) or as artifact because of annotation of noise or interpolation in areas of incomplete mapping (n=22; median 1, quartiles 0-2 per map). Pseudo-reentrant carousels were incorrectly ablated in 5 cases having been misinterpreted as LR.
The activation pattern of LR is of small stable rotational activations (carousels), and this drove 30% (7/23) of our postablation atrial tachycardias. However, this appearance is most often pseudo-reentrant and must be differentiated by interpretation of electrograms in the candidate circuit and activation in the wider surrounding region.
房性心动过速中局灶性折返（LR）的激活模式仍未完全明确。我们使用超高密度Rhythmia标测系统研究LR中的激活模式。
包含全频谱颜色编码图的小旋转激活（旋转木马样）提示存在LR。对15例患者（年龄：64±11岁）的23例左侧房性心动过速进行了标测。每张图显示16253±9192个点，采集时间为26±14分钟。共识别出50个旋转木马样图形（中位数为2；每张图标测的四分位数间距为1 - 3），尽管其中只有7个（14%）代表LR：在此情况下，旋转围绕小面积瘢痕（<0.03 mV；直径12±6 mm）发生。在LR中，沿旋转木马样图形的电图涵盖整个心动过速周期长度，且周围的激活从旋转木马样图形向各个方向扩散。消融旋转木马样图形内的碎裂电图（117±18 ms；心动过速周期长度的44±13%）可终止每例LR患者的心动过速。其余所有旋转木马样图形均为伪折返（43/50 [86%]），发生于波前碰撞区域（21例；中位数为0.5；每张图标测的四分位数间距为0 - 2），或因在不完全标测区域对噪声进行注释或插值而产生的伪迹（22例；中位数为1，每张图标测的四分位数间距为0 - 2）。5例假被误判为LR的病例中，伪折返性旋转木马样图形被错误消融。
LR的激活模式为小的稳定旋转激活（旋转木马样），这导致我们30%（7/23）的消融后房性心动过速。然而，这种表现大多为伪折返，必须通过解读候选环路中的电图以及更广泛周边区域的激活情况加以区分。
