Proietti Riccardo, Adlan Ahmed M, Dowd Rory, Assadullah Shershah, Aldhoon Bashar, Panikker Sandeep, Foster Will, Yusuf Shamil, Hayat Sajad, Osman Faizel, Banerjee Prithwish, Dhanjal Tarvinder
Department of Cardiac, Thoracic, Vascular Sciences, University of Padua, Padua, Italy.
Department of Cardiology, University Hospital Coventry, University Hospital, Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.
J Interv Card Electrophysiol. 2020 Sep;58(3):355-362. doi: 10.1007/s10840-019-00625-9. Epub 2019 Oct 9.
Defining diastolic slow-conduction channels within the borderzone (BZ) of scar-dependent re-entrant ventricular tachycardia (VT) is key for effective mapping and ablation strategies. Understanding wavefront propagation is driving advances in high-density (HD) mapping. The newly developed Advisor™ HD Grid Mapping Catheter (HD GRID) has equidistant spacing of 16, 1 mm electrodes in a 4 × 4 3 mm interspaced arrangement allowing bipolar recordings along and uniquely across the splines (orthogonal vector) to facilitate substrate mapping in a WAVE configuration (WAVE). The purpose of this study was to determine the relative importance of the WAVE configuration compared to the STANDARD linear-only bipolar configuration (STANDARD) in defining VT substrate.
Thirteen patients underwent VT ablation at our institution. In all cases, a substrate map was constructed with the HD GRID in the WAVE configuration (conWAVE) to guide ablation strategy. At the end of the procedure, the voltage map was remapped in the STANDARD configuration (conSTANDARD) using the turbo-map function. Detailed post-hoc analysis of the WAVE and STANDARD maps was performed blinded to the configuration. Quantification of total scar area, BZ and dense scar area with assessment of conduction channels (CC) was performed.
The substrate maps conSTANDARD vs conWAVE showed statistically significant differences in the total scar area (56 ± 32 cm vs 51 ± 30 cm; p = 0.035), dense scar area (36 ± 25 cm vs 29 ± 22 cm; p = 0.002) and number of CC (3.3 ± 1.6 vs 4.8 ± 2.5; p = 0.026). conWAVE collected more points than the conSTANDARD settings (p = 0.001); however, it used fewer points in map construction (p = 0.023).
The multipolar Advisor™ HD Grid Mapping Catheter in conWAVE provides more efficient point acquisition and greater VT substrate definition of the borderzone particularly at the low-voltage range compared to conSTANDARD. This greater resolution within the low-voltage range facilitated CC definition and quantification within the scar, which is essential in guiding the ablation strategy.
确定瘢痕依赖性折返性室性心动过速（VT）边界区（BZ）内的舒张期缓慢传导通道是有效标测和消融策略的关键。了解波前传播推动了高密度（HD）标测技术的发展。新开发的Advisor™ HD网格标测导管（HD GRID）在4×4、3毫米间距的排列中有16个间距为1毫米的电极，允许沿样条并独特地跨样条（正交向量）进行双极记录，以利于在WAVE配置（WAVE）中进行基质标测。本研究的目的是确定在定义VT基质方面，WAVE配置相对于仅采用标准线性双极配置（STANDARD）的相对重要性。
13例患者在我们机构接受VT消融。在所有病例中，使用HD GRID以WAVE配置（conWAVE）构建基质图以指导消融策略。在手术结束时，使用涡轮标测功能以标准配置（conSTANDARD）重新绘制电压图。对WAVE和标准图进行详细的事后分析，分析时对配置情况不知情。进行总瘢痕面积、BZ和致密瘢痕面积的量化，并评估传导通道（CC）。
conSTANDARD与conWAVE的基质图在总瘢痕面积（56±32平方厘米对51±30平方厘米；p = 0.035）、致密瘢痕面积（36±25平方厘米对29±22平方厘米；p = 0.002）和CC数量（3.3±1.6对4.8±2.5；p = 0.026）方面显示出统计学上的显著差异。conWAVE比conSTANDARD设置采集的点更多（p = 0.001）；然而，它在图构建中使用的点更少（p = 0.023）。
与conSTANDARD相比，conWAVE中的多极Advisor™ HD网格标测导管提供了更高效的点采集，并且对边界区尤其是低电压范围内的VT基质有更好的定义。低电压范围内更高的分辨率有助于在瘢痕内定义和量化CC，这对指导消融策略至关重要。
