Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California.
Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California.
Heart Rhythm. 2020 Mar;17(3):476-484. doi: 10.1016/j.hrthm.2019.10.013. Epub 2019 Oct 10.
Ventricular bipolar voltage values <0.5 and <1.0/1.5 mV (epi- and endocardium) correlating with dense scar and border zone, respectively, were established using a 3.5-mm tip catheter. Novel microelectrode catheters promise improved mapping resolution; however, whether standard voltage criteria apply to catheters with smaller electrode size and interelectrode distance remains unclear.
The purpose of this study was to determine whether traditional bipolar voltage criteria for scar apply during substrate mapping with a microelectrode catheter.
Paired bipolar and microbipolar voltage values were acquired from control swine (n = 2) using the microelectrode catheter and assessed for systemic differences. In a postinfarction swine model (n = 6), scar characteristics were compared between the bipolar maps and microbipolar maps using both standard and adjusted voltage criteria derived from the control animals.
In control swine, although 5th percentile values for bipolar and microbipolar voltage were similar (1.12 vs 1.22 mV [left ventricular (LV) endo]; 0.88 mV vs 0.98 mV [epi]), median values were significantly greater when acquired by microbipolar electrodes (3.60 vs 6.76 mV, P = .002 [LV endo]; 2.61 vs 2.72 mV, P = .02 [epi]). Microbipolar values were systematically larger by 2.0× and 1.4× in the LV endocardium and epicardium, respectively. Application of standard voltage values to microbipolar maps in postinfarct swine underestimated scar area by approximately 41% in the LV endocardium (13.7 vs 33.4 cm, P = .004).
Bipolar voltage values acquired from microelectrodes are systemically larger than those acquired from standard catheters. New reference values should be established for these novel catheters.
使用尖端为 3.5mm 的导管确定了心室双极电压值<0.5 和<1.0/1.5mV（心外膜和心内膜），分别与致密瘢痕和边界区相关。新型微电极导管有望提高映射分辨率；然而，对于电极尺寸和电极间距离较小的导管，标准电压标准是否适用尚不清楚。
本研究旨在确定在使用微电极导管进行基质标测时，传统的瘢痕双极电压标准是否适用。
使用微电极导管从对照猪（n=2）获取配对的双极和微双极电压值，并评估其系统差异。在心肌梗死猪模型中（n=6），使用标准和从对照动物中得出的调整后的电压标准，比较双极图和微双极图之间的瘢痕特征。
在对照猪中，尽管双极和微双极电压的第 5 百分位值相似（左心室（LV）心内膜为 1.12 对 1.22mV；心外膜为 0.88mV 对 0.98mV），但使用微双极电极获取时，中位数明显更高（LV 心内膜为 3.60 对 6.76mV，P=0.002；心外膜为 2.61 对 2.72mV，P=0.02）。微双极值在心内膜和心外膜中分别大 2.0 倍和 1.4 倍。在心肌梗死猪中，将标准电压值应用于微双极图会使 LV 心内膜的瘢痕面积低估约 41%（13.7 对 33.4cm，P=0.004）。
从微电极获得的双极电压值系统地大于从标准导管获得的电压值。这些新型导管应建立新的参考值。
