Nührich Jana M, Kaiser Lukas, Akbulak Ruken Özge, Schäffer Benjamin N, Eickholt Christian, Schwarzl Michael, Kuklik Pawel, Moser Julia, Jularic Mario, Willems Stephan, Meyer Christian
Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany.
Department of Interventional Cardiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany.
J Cardiovasc Electrophysiol. 2017 Sep;28(9):1058-1067. doi: 10.1111/jce.13270. Epub 2017 Jul 3.
Ablation of scar-related ventricular tachycardia (VT), especially in noninducible VT or hemodynamically unstable patients, can be challenging. Thus, we evaluated feasibility of an ultra high-density 3-D mapping approach to characterize the ventricular substrate and, if possible, to map VT.
Twenty-two patients (67 ± 2 years, mean LV-EF 36 ± 3%) with both ischemic and nonischemic cardiomyopathy and documented VT underwent mapping and catheter ablation using a 64-electrode mini-basket catheter. Substrate characterization included ultra high-density voltage maps, identification of areas of slow conduction and late potentials. Whenever VT was inducible activation mapping was performed. In 13 of 22 patients, the presumed clinical VT (in 16 of 22 any VT) was inducible. A total of 50 maps were generated (22 substrate maps, 28 during VT), mapping time was 33 ± 4 minutes, number of points was 10,937 ± 1,923. Low voltage areas were related with the site of origin in all mapped VT. Isochronal maps indicated areas of slow conduction in 14 of 22 patients, all in border zone scar. In 95% of patients, late potentials were found. Mapping time during VT was 9 ± 2 minutes, number of points 6,740 ± 1,140. Covered cycle length was 82 ± 5% (16 re-entry, 10 focal, and two undetermined). During 4 months follow-up, 90% remained free from VT recurrence.
Ultra high-density mapping in patients with scar-related VT is feasible, safe and enables detailed insight into tachycardia mechanisms. Critical sites can be identified (1) by precise substrate characterization when VT is not inducible or hemodynamically not tolerated and (2) during short lasting episodes of VT in order to guide catheter ablation.
消融与瘢痕相关的室性心动过速（VT）具有挑战性，尤其是对于不能诱发VT或血流动力学不稳定的患者。因此，我们评估了一种超高密度三维标测方法用于明确心室基质并在可能时标测VT的可行性。
22例患有缺血性和非缺血性心肌病且记录有VT的患者（年龄67±2岁，平均左室射血分数36±3%）接受了使用64极微型篮状导管进行的标测和导管消融。基质特征分析包括超高密度电压图、缓慢传导区域和晚电位的识别。只要能诱发VT，就进行激动标测。22例患者中有13例可诱发推测的临床VT（22例中有16例可诱发任何VT）。共生成了50张图（22张基质图，28张VT发作时的图），标测时间为33±4分钟，标测点数为10937±1923。所有标测到的VT中，低电压区域均与起源部位相关。等时线图显示22例患者中有14例存在缓慢传导区域，均位于边界区瘢痕处。95%的患者发现有晚电位。VT发作时的标测时间为9±2分钟，标测点数为6740±1140。覆盖的心动周期长度为82±5%（16例折返性、10例局灶性和2例不明）。在4个月的随访期间，90%的患者未出现VT复发。
对于与瘢痕相关的VT患者，超高密度标测是可行、安全的，并且能够深入了解心动过速机制。关键部位可在以下情况被识别：（1）当VT不能诱发或血流动力学不能耐受时，通过精确的基质特征分析；（2）在VT短暂发作期间，以指导导管消融。
