Luther Vishal, Cortez-Dias Nuno, Carpinteiro Luís, de Sousa João, Balasubramaniam Richard, Agarwal Sharad, Farwell David, Sopher Mark, Babu Girish, Till Richard, Jones Nikki, Tan Stuart, Chow Anthony, Lowe Martin, Lane Jem, Pappachan Naveen, Linton Nicholas, Kanagaratnam Prapa
Cardiac Electrophysiology Laboratories, Imperial College Healthcare, London, UK.
Department of Cardiac Electrophysiology, Hospital de Santa Maria, Lisbon, Portugal.
J Cardiovasc Electrophysiol. 2017 Nov;28(11):1285-1294. doi: 10.1111/jce.13308. Epub 2017 Aug 29.
Ripple mapping (RM) displays electrograms as moving bars over a three-dimensional surface displaying bipolar voltage, and has shown in a single-center series to be effective for atrial tachycardia (AT) mapping without annotation of local activation time or window-of-interest assignment. We tested the reproducibility of these findings in operators naïve to RM, using it for the first time in postablation AT.
Maps were collected with multielectrode catheters and CARTO ConfiDENSE. A diagnosis of the tachycardia mechanism was made using RM and an assessment of operator confidence was made according to a three-grade scale (1 highest-3 lowest).
The first 20 patients (64 ± 9 years, median two previous ablations) undergoing RM-guided AT ablation across five sites were studied. High-density maps (2,935 ± 1,328 points) in AT (CL = 296 ± 95 milliseconds) were collected. Macroreentrant ATs bordered by scar or anatomical obstacles were identified in n = 12 (60%), small reentrant ATs around scar in n = 3 (15%), and focal ATs from scar in n = 5 (25%). Diagnostic confidence with RM was grade 1 in n = 13 (65%), where operators felt confident to proceed to ablation without entrainment. Ablation offered the correct diagnosis n = 18 (90%). Retrospective review of the accompanying LAT maps demonstrated potential sources for error related to the window of interest selection, interpolation, and differentiating regions of scar during tachycardia on the voltage map.
RM was easy to adopt by operators using it for the first time, and identified the correct target for ablation with high diagnostic confidence in most cases of complex AT.
涟漪映射（RM）将心内电图显示为三维表面上移动的条带，显示双极电压，并且在单中心系列研究中已表明，对于心房性心动过速（AT）标测，无需标注局部激动时间或指定感兴趣窗口即可有效。我们在对RM不熟悉的操作者中测试了这些发现的可重复性，首次将其用于消融术后AT。
使用多电极导管和CARTO ConfiDENSE收集标测图。使用RM做出心动过速机制的诊断，并根据三级量表（1最高 - 3最低）对操作者的信心进行评估。
研究了在五个地点接受RM引导的AT消融的前20例患者（64±9岁，既往消融中位数为两次）。收集了AT（CL = 296±95毫秒）中的高密度标测图（2,935±1,328个点）。在n = 12例（60%）中识别出由瘢痕或解剖学障碍物界定的大折返性AT，在n = 3例（15%）中识别出瘢痕周围的小折返性AT，在n = 5例（25%）中识别出源于瘢痕的局灶性AT。RM的诊断信心在n = 13例（65%）中为1级，此时操作者感觉有信心在不进行拖带的情况下进行消融。消融给出正确诊断的有n = 18例（90%）。对随附的局部激动时间（LAT）标测图的回顾性分析显示，在心动过速期间，电压标测图上与感兴趣窗口选择、插值以及区分瘢痕区域相关的潜在误差来源。
RM对于首次使用它的操作者来说易于采用，并且在大多数复杂AT病例中以高诊断信心识别出正确的消融靶点。
