Department of Cardiac Electrophysiology, Northwell Health-Lenox Hill Heart and Lung, New York, New York.
Department of Cardiac Electrophysiology, Northwell Health-Lenox Hill Heart and Lung, New York, New York.
Heart Rhythm. 2019 Oct;16(10):1562-1569. doi: 10.1016/j.hrthm.2019.04.026. Epub 2019 Apr 17.
Idiopathic arrhythmias commonly arise from the septal right ventricular outflow tract (RVOT), sinuses of Valsalva (SoV), and great cardiac vein (GCV). Predicting the exact site of origin is important for preparation for catheter ablation.
The purpose of this study was to examine the diagnostic value of noninvasive electroanatomic mapping (NIEAM) to differentiate between septal RVOT, SoV, and GCV origin and compare it to that of 12-lead electrocardiography (ECG).
NIEAM maps (CardioInsight, Medtronic) were generated during spontaneous ventricular premature depolarizations (VPDs) and threshold pacing from septal RVOT, SoV, and GCV. Origin prediction using NIEAM was compared to algorithmic ECG criteria (maximal deflection index; V transition ratio) and subjective ECG evaluation.
Sixty NIEAMs (18 spontaneous VPDs and 42 pace-maps) from 31 patients (age 56 ± 16 years) were analyzed. NIEAM showed distinct conduction patterns, best visualized at the base of the heart: septal RVOT VPDs propagate toward the tricuspid annulus, depolarizing the septum from inferior to superior; SoV VPDs engage the superior septum early; and GCV VPDs move laterally along the mitral annulus, depolarizing the heart from left to right. Activation of the lateral mitral annulus >60.50 ms and the superior basal septum <22.5 ms from onset predicts RVOT and SoV origin, respectively, in 100% of cases. NIEAM was superior to maximum deflection index in predicting GCV origin (100% vs 42.2% accuracy) and superior to V transition ratio in predicting SoV origin (100% vs 75.9% accuracy).
Arrhythmias arising from the outflow tracts follow distinct propagation patterns depending on the origin. A 2-step algorithm using activation timing by NIEAM yields 100% diagnostic accuracy in predicting origin.
特发性心律失常通常起源于间隔右心室流出道（RVOT）、瓦尔萨尔瓦窦（SoV）和心大静脉（GCV）。准确预测起源部位对于导管消融准备非常重要。
本研究旨在检查非侵入性电解剖标测（NIEAM）区分间隔 RVOT、SoV 和 GCV 起源的诊断价值，并与 12 导联心电图（ECG）进行比较。
在间隔 RVOT、SoV 和 GCV 进行自发性室性期前收缩（VPD）和阈下起搏时生成 NIEAM 图谱。使用 NIEAM 进行起源预测，并与算法 ECG 标准（最大偏转指数；V 转换比）和主观 ECG 评估进行比较。
对 31 名患者（年龄 56 ± 16 岁）的 60 个 NIEAMs（18 个自发性 VPD 和 42 个起搏图）进行了分析。NIEAM 显示出不同的传导模式，在心脏底部最佳显示：间隔 RVOT VPD 向三尖瓣环传播，从下至上激动间隔；SoV VPD 早期激活上间隔；GCV VPD 沿二尖瓣环向外侧移动，从左至右激动心脏。从起始开始，外侧二尖瓣环的激活时间＞60.50ms 和上基底间隔＜22.5ms 可分别预测 RVOT 和 SoV 起源，准确率为 100%。NIEAM 在预测 GCV 起源方面优于最大偏转指数（准确率 100%比 42.2%），在预测 SoV 起源方面优于 V 转换比（准确率 100%比 75.9%）。
起源于流出道的心律失常根据起源呈现出不同的传播模式。使用 NIEAM 的激活时间的两步算法可实现 100%的起源预测准确率。
