Rodrigo M, Climent A M, Liberos A, Fernández-Aviles F, Atienza F, Guillem M S, Berenfeld O
ITACA, Universitat Politècnica de València, Valencia, Spain.
CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de investigación sanitaria Gregorio Marañón, Madrid, Spain.
Pacing Clin Electrophysiol. 2017 Aug;40(8):940-946. doi: 10.1111/pace.13133. Epub 2017 Jul 12.
Ablation of drivers maintaining atrial fibrillation (AF) has been demonstrated as an effective therapy. Drivers in the form of rapidly activated atrial regions can be noninvasively localized to either left or right atria (LA, RA) with body surface potential mapping (BSPM) systems. This study quantifies the accuracy of dominant frequency (DF) measurements from reduced-leads BSPM systems and assesses the minimal configuration required for ablation guidance.
Nine uniformly distributed lead sets of eight to 66 electrodes were evaluated. BSPM signals were registered simultaneously with intracardiac electrocardiograms (EGMs) in 16 AF patients. DF activity was analyzed on the surface potentials for the nine leads configurations, and the noninvasive measures were compared with the EGM recordings.
Surface DF measurements presented similar values than panoramic invasive EGM recordings, showing the highest DF regions in corresponding locations. The noninvasive DFs measures had a high correlation with the invasive discrete recordings; they presented a deviation of <0.5 Hz for the highest DF and a correlation coefficient of >0.8 for leads configurations with 12 or more electrodes.
Reduced-leads BSPM systems enable noninvasive discrimination between LA versus RA DFs with similar results as higher-resolution 66-leads system. Our findings demonstrate the possible incorporation of simplified BSPM systems into clinical planning procedures for AF ablation.
消融维持心房颤动（AF）的驱动因素已被证明是一种有效的治疗方法。通过体表电位标测（BSPM）系统，可以将快速激活的心房区域形式的驱动因素无创定位到左心房或右心房（LA，RA）。本研究量化了简化导联BSPM系统中主导频率（DF）测量的准确性，并评估了消融指导所需的最小配置。
评估了9组均匀分布的导联组，每组有8至66个电极。在16例AF患者中，将BSPM信号与心内心电图（EGM）同时记录。分析了9种导联配置的表面电位上的DF活动，并将无创测量结果与EGM记录进行比较。
表面DF测量值与全景有创EGM记录相似，在相应位置显示出最高的DF区域。无创DF测量与有创离散记录高度相关；对于最高DF，它们的偏差<0.5 Hz，对于12个或更多电极的导联配置，相关系数>0.8。
简化导联BSPM系统能够对LA与RA的DF进行无创区分，结果与更高分辨率的66导联系统相似。我们的研究结果表明，简化的BSPM系统可能纳入AF消融的临床规划程序。
