Kubala Maciej, Lucena-Padros Irene, Xie Shuanglun, Casado-Arroyo Ruben, Frankel David S, Lin David, Santangeli Pasquale, Supple Gregory E, Dixit Sanjay, Tschabrunn Cory M, Liang Jackson J, Yang Jiandu, Hyman Matthew C, Zado Erica S, Marchlinski Francis E
Cardiac Electrophysiology Program, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
J Cardiovasc Electrophysiol. 2019 Jun;30(6):865-876. doi: 10.1111/jce.13899. Epub 2019 Mar 12.
Nonpulmonary vein (non-PV) triggers of atrial fibrillation (AF) are targets for ablation but their localization remains challenging. The aim of this study was to describe P-wave (PW) morphologic characteristics and intra-atrial activation patterns and timing from multipolar coronary sinus (CS) and crista terminalis (CT) catheters that localize non-PV triggers.
Selective pacing from six right and nine left atrial common non-PV trigger sites was performed in 30 consecutive patients. We analyzed 12 lead ECG features based on PW duration, amplitude and morphology, and patterns and timing of multipolar activation for all 15 sites. Regionalization and then precise localization required criteria present in at least 70% of assessments at each pacing site. The algorithm was then prospectively evaluated by four blinded observers in a validation cohort of 18 consecutive patients undergoing the same pacing protocol and 60 consecutive patients who underwent successful non-PV trigger ablation. The algorithm for site regionalization included 1) negative PW in V1, ≥30 µV change in PW amplitude across the leads V1-V3, and PW duration ≤100 milliseconds in lead 2 and 2) unique intra-atrial activation patterns and timing noted in the multipolar catheters. Specific ECG and intra-atrial activation timing characteristics included in the algorithm allowed for more precise site localization after regionalization. In the prospective evaluation, the algorithm identified the site of origin for 72% of paced and 70% of spontaneous non-PV trigger sites.
An algorithm based on PW morphology and intra-atrial multipolar activation pattern and timing can help identify non-PV trigger sites of origin.
心房颤动（AF）的非肺静脉（non-PV）触发灶是消融治疗的靶点，但其定位仍然具有挑战性。本研究的目的是描述P波（PW）形态特征、心房内激动模式以及来自多极冠状窦（CS）和终末嵴（CT）导管的激动时间，这些导管用于定位非PV触发灶。
对30例连续患者从6个右心房和9个左心房常见的非PV触发灶部位进行选择性起搏。我们分析了所有15个部位基于PW持续时间、振幅和形态的12导联心电图特征，以及多极激动的模式和时间。区域化然后精确的定位需要每个起搏部位至少70%的评估中存在的标准。然后，由4名盲法观察者对18例接受相同起搏方案的连续患者和60例成功进行非PV触发灶消融的连续患者组成的验证队列进行前瞻性评估。部位区域化算法包括：1）V1导联PW为负，V1-V3导联PW振幅变化≥30µV，以及II导联PW持续时间≤100毫秒；2）在多极导管中观察到的独特心房内激动模式和时间。该算法中包含的特定心电图和心房内激动时间特征允许在区域化后进行更精确的部位定位。在前瞻性评估中，该算法确定了72%的起搏非PV触发灶部位和70%的自发非PV触发灶部位的起源部位。
基于PW形态、心房内多极激动模式和时间的算法有助于识别非PV触发灶的起源部位。
