Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia.
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Cardiology, Western Health, Melbourne, Australia.
Heart Rhythm. 2017 Oct;14(10):1541-1549. doi: 10.1016/j.hrthm.2017.06.021. Epub 2017 Jun 16.
With the recent advent of high-density (HD) 3-dimensional (3D) mapping, the utility of entrainment is uncertain. However, the limitations of visual representation and interpretation of these high-resolution 3D maps are unclear.
The purpose of this study was to determine the strengths and limitations of both HD 3D mapping and entrainment mapping during mapping of right atrial macroreentry.
Fifteen patients were studied. The number and type of circuits accounting for ≥90% of the tachycardia cycle length using HD 3D mapping were verified using systematic entrainment mapping. Entrainment sites with an unexpectedly long postpacing interval despite proximity to the active circuit were evaluated.
Based on HD 3D mapping, 27 circuits were observed: 12 peritricuspid, 2 upper loop reentry, 10 lower loop reentry, and 3 lateral wall circuits. With entrainment, 17 of the 27 circuits were active: all 12 peritricuspid and 2 upper loop reentry. However, lower loop reentry was confirmed in only 3 of 10, and none of the 3 lateral wall circuits were present. Mean percentage of tachycardia cycle length covered by active circuits was 98% ± 1% vs 97% ± 2% for passive circuits (P = .09). None of the 345 entrainment runs terminated tachycardia or changed tachycardia mechanism. In 8 of 15 patients, 13 examples of unexpectedly long postpacing interval were observed at entrainment sites located distal to localized zones of slow conduction seen on HD 3D mapping.
Using HD 3D mapping, "visual reentry" may be due to passive circuitous propagation rather than a critical reentrant circuit. HD 3D mapping provides new insights into regional conduction and helps explain unusual entrainment phenomena.
随着高密度（HD）三维（3D）地图的出现，entrainment 的实用性尚不确定。然而，这些高分辨率 3D 地图的视觉表现和解释的局限性尚不清楚。
本研究旨在确定在右房宏观折返标测中使用 HD 3D 映射和 entrainment 映射的优缺点。
研究了 15 例患者。使用 HD 3D 映射验证了占心动过速周期长度≥90%的回路的数量和类型，并用系统的 entrainment 映射进行验证。尽管靠近主动回路，但起搏后间期异常长的 entrainment 部位进行了评估。
基于 HD 3D 映射，观察到 27 个回路：12 个围绕三尖瓣、2 个上环折返、10 个下环折返和 3 个侧壁回路。通过 entrainment，27 个回路中有 17 个是活跃的：所有 12 个围绕三尖瓣和 2 个上环折返。然而，只有 3 个下环折返得到证实，3 个侧壁回路均不存在。活跃回路覆盖心动过速周期长度的平均百分比为 98%±1%，而被动回路为 97%±2%（P=0.09）。345 次 entrainment 试验均未终止心动过速或改变心动过速机制。在 15 例患者中的 8 例中，在 HD 3D 映射上看到的局部传导缓慢的区域远端的 entrainment 部位观察到 13 个起搏后间期异常长的实例。
使用 HD 3D 映射，“视觉折返”可能是由于被动的迂回传播而不是关键的折返环。HD 3D 映射提供了对区域传导的新见解，并有助于解释异常的 entrainment 现象。
