Vicera Jennifer Jeanne B, Lo Li-Wei, Shinya Yamada, Chou Yu-Hui, Lin Yenn-Jiang, Lo Men-Tzung, Lin Wei-Lun, Liu Shin-Huei, Cheng Wen-Han, Tsai Tsung-Ying, Chen Shih-Ann
Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.
J Cardiovasc Electrophysiol. 2019 Jun;30(6):952-963. doi: 10.1111/jce.13952. Epub 2019 May 6.
Phase singularity (PS) mapping provides additional insight into the AF mechanism and is accurate in identifying rotors. The study aimed to evaluate the feasibility of PS mapping in identifying AF rotors using data obtained from an automatic ultra-rapid high-resolution mapping system with a high-density mini-basket catheter.
Twenty-three pigs underwent rapid right atrial (RA) pacing (RAP 480 bpm) for 5 weeks before the experiment. During AF, RA endocardial automatic continuous mappings with a mini-basket catheter were generated using an automatic ultra-rapid mapping system. Both fractionation mapping and waveform similarity measurements using a PS mapping algorithm were applied on the same recording signals to localize substrates maintaining AF.
Seventeen (74%) pigs developed sustained AF after RAP. Three were excluded because of periprocedural ventricular arrhythmia and corrupted digital data. RA fractionation maps were acquired with 6.17 ± 4.29 minutes mean acquisition time, 13768 ± 12698 acquisition points mapped during AF from 581 ± 387 beats. Fractionation mapping identified extensively distributed (66.7%) RA complex fractionated atrial electrogram (CFAE), whereas the nonlinear analysis identified high similarity index (SI > 0.7) parts in limited areas (23.7%). There was an average of 1.67 ± 0.87 SI sites with 0.43 ± 0.76 rotor/focal source/chamber. AF termination occurred in 11/16 (68.75%) AF events in 14 pigs during ablation targeting max CFAE. There was a higher incidence of rotor/focal source at AF termination sites compared with non-AF termination sites (54.5% vs 0%, P = 0.011).
The data obtained from ultra-rapid high-density automatic mapping is feasible and effective in identifying AF rotors/focal sources using PS technique, and those critical substrates were closely related to AF procedural termination.
相位奇点（PS）映射为房颤机制提供了更多见解，并且在识别转子方面很准确。本研究旨在使用从配备高密度微型篮状导管的自动超快速高分辨率映射系统获得的数据，评估PS映射在识别房颤转子方面的可行性。
23头猪在实验前接受了5周的右心房快速起搏（RAP 480次/分钟）。在房颤期间，使用自动超快速映射系统通过微型篮状导管生成右心房内膜自动连续映射。将使用PS映射算法的碎裂映射和波形相似性测量应用于相同的记录信号，以定位维持房颤的基质。
17头（74%）猪在RAP后发生持续性房颤。3头因围手术期室性心律失常和数字数据损坏而被排除。右心房碎裂图的平均采集时间为6.17±4.29分钟，房颤期间从581±387次搏动中映射了13768±12698个采集点。碎裂映射识别出广泛分布（66.7%）的右心房复杂碎裂心房电图（CFAE），而非线性分析在有限区域（23.7%）识别出高相似性指数（SI>0.7）的部分。平均有1.67±0.87个SI位点，每0.43±0.76个转子/局灶源/腔室。在针对最大CFAE进行消融期间，14头猪的11/16（68.75%）次房颤事件发生了房颤终止。与非房颤终止部位相比，房颤终止部位的转子/局灶源发生率更高（54.5%对0%，P=0.011）。
从超快速高密度自动映射获得的数据在使用PS技术识别房颤转子/局灶源方面是可行且有效的，并且那些关键基质与房颤手术终止密切相关。
