Sultan Arian, Bellmann Barbara, Lüker Jakob, Plenge Tobias, van den Bruck Jan-Hendrik, Filipovic Karlo, Erlhöfer Susanne, Kuffer Liz, Arica Zeynep, Steven Daniel
Department of Electrophysiology, University of Cologne, Kerpener Straße 62, 50937, Köln, Germany.
J Interv Card Electrophysiol. 2019 Sep;55(3):287-295. doi: 10.1007/s10840-019-00530-1. Epub 2019 Mar 7.
First experiences using a 64-electrode mini-basket catheter (BC) paired with an automatic mapping system (Rhythmia™) for catheter ablation (CA) of ventricular ectopy (VE) and ventricular tachycardia (VT) have been reported.
We aimed to evaluate (1) differences in ventricular access for the BC and (2) benefit of this technology in the setting of standard clinical practice.
Patients (pts) undergoing CA for VE or VT using the Intellamap Orion™ paired with the Rhythmia™ automated-mapping system were included in this study. For LV access, transseptal and retrograde access were compared.
All 32 pts (29 men, age 63 ± 15 years) underwent CA for VE (17 pts) or VT (15 pts). For mapping of VE originating from the left ventricle (LV) in 10 out of 13 pts, a transaortic access was feasible. The predominant access for CA of VT was transaortic (5/7). Feasibility and safety seem to be equal. The total procedure time was 179.1 ± 21.2 min for VE ablation and 212.0 ± 71.7 min for VT ablation (p = 0.177). For VE, an acquisition of 1602 ± 1672 map points and annotation of 140 ± 98 automated mapping points sufficed to abolish VE in all pts. During a 6-month follow-up (FU) after CA for VE, a VE burden reduction from 18.5 ± 2.1% to 2.8 ± 2.2% (p = 0.019) was achieved. In VT pts, one patient showed recurrence of sustained VT episodes during FU.
Use of a high-resolution mapping system for VE/VT CA potentially facilitates revelation of VE origin and VT circuits in the setting of standard clinical practice. Feasibility and safety of a venous, transaortic, transseptal, or a combined approach seem to be equal.
已有报道首次使用64极微型篮状导管（BC）与自动标测系统（Rhythmia™）联合进行室性期前收缩（VE）和室性心动过速（VT）的导管消融（CA）的经验。
我们旨在评估（1）BC的心室入路差异，以及（2）该技术在标准临床实践中的益处。
本研究纳入了使用Intellamap Orion™与Rhythmia™自动标测系统联合进行VE或VT的CA的患者（pts）。对于左心室（LV）入路，比较了经间隔和逆行入路。
所有32例患者（29例男性，年龄63±15岁）接受了VE（17例）或VT（15例）的CA。对于13例患者中10例源自左心室（LV）的VE标测，经主动脉入路是可行的。VT的CA的主要入路是经主动脉（5/7）。可行性和安全性似乎相当。VE消融的总手术时间为179.1±21.2分钟，VT消融的总手术时间为212.0±71.7分钟（p = 0.177）。对于VE，采集1602±1672个标测点并标注140±98个自动标测点足以消除所有患者的VE。在VE的CA术后6个月随访（FU）期间，VE负荷从18.5±2.1%降至2.8±2.2%（p = 0.019）。在VT患者中，1例患者在FU期间出现持续性VT发作复发。
在标准临床实践中，使用高分辨率标测系统进行VE/VT的CA可能有助于揭示VE起源和VT环路。静脉、经主动脉、经间隔或联合入路的可行性和安全性似乎相当。
