Alken Fares-Alexander, Klatt Niklas, Muenkler Paula, Scherschel Katharina, Jungen Christiane, Akbulak Ruken Oezge, Kahle Ann-Kathrin, Gunawardene Melanie, Jularic Mario, Dinshaw Leon, Hartmann Jens, Eickholt Christian, Willems Stephan, Stute Fridrike, Mueller Goetz, Blankenberg Stefan, Rickers Carsten, Sinning Christoph, Zengin-Sahm Elvin, Meyer Christian
Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
Cardiovasc Diagn Ther. 2019 Oct;9(Suppl 2):S247-S263. doi: 10.21037/cdt.2019.10.02.
Ultra-high density mapping (HDM) is a promising tool in the treatment of patients with complex arrhythmias. In adults with congenital heart disease (CHD), rhythm disorders are among the most common complications but catheter ablation can be challenging due to heterogenous anatomy and complex arrhythmogenic substrates. Here, we describe our initial experience using HDM in conjunction with novel automated annotation algorithms in patients with moderate to great CHD complexity.
We studied a series of consecutive adult patients with moderate to great CHD complexity and an indication for catheter ablation due to symptomatic arrhythmia. HDM was conducted using the Rhythmia™ mapping system and a 64-electrode mini-basket catheter for identification of anatomy, voltage, activation pattern and critical areas of arrhythmia for ablation guidance. To investigate novel advanced mapping strategies, postprocedural signal processing using the Lumipoint™ software was applied.
In 19 patients (53±3 years; 53% male), 21 consecutive ablation procedures were conducted. Procedures included ablation of atrial fibrillation (n=7; 33%), atrial tachycardia (n=11; 52%), atrioventricular accessory pathway (n=1; 5%), the atrioventricular node (n=1; 5%) and ventricular arrhythmias (n=4; 19%). A total of 23 supraventricular and 8 ventricular arrhythmias were studied with the generation of 56 complete high density maps (atrial n=43; ventricular n=11, coronary sinus n=2) and an average of 12,043±1,679 mapping points. Multiple arrhythmias were observed in n=7 procedures (33% of procedures; range of arrhythmias detected 2-4). A total range of 1-4 critical areas were defined per procedure and treated within a radiofrequency application time of 16 (interquartile range 12-45) minutes. Postprocedural signal processing using Lumipoint™ allowed rapid annotation of fractionated signals within specific windows of interest. This supported identification of a practical critical isthmus in 20 out of 27 completed atrial and ventricular tachycardia activation maps.
Our findings suggest that HDM in conjunction with novel automated annotation algorithms provides detailed insights into arrhythmia mechanisms and might facilitate tailored catheter ablation in patients with moderate to great CHD complexity.
超高密度标测（HDM）是治疗复杂心律失常患者的一种有前景的工具。在患有先天性心脏病（CHD）的成人中，节律紊乱是最常见的并发症之一，但由于解剖结构异质性和复杂的致心律失常基质，导管消融可能具有挑战性。在此，我们描述了在具有中度至高度CHD复杂性的患者中联合使用HDM和新型自动注释算法的初步经验。
我们研究了一系列具有中度至高度CHD复杂性且因症状性心律失常而有导管消融指征的连续成年患者。使用Rhythmia™标测系统和64电极微型篮状导管进行HDM，以识别解剖结构、电压、激动模式和心律失常的关键区域，用于消融指导。为了研究新型高级标测策略，应用了使用Lumipoint™软件的术后信号处理。
在19例患者（53±3岁；53%为男性）中，连续进行了21次消融手术。手术包括房颤消融（n = 7；33%）、房性心动过速消融（n = 11；52%）、房室旁道消融（n = 1；5%）、房室结消融（n = 1；5%）和室性心律失常消融（n = 4；19%）。共研究了23例室上性和8例室性心律失常，生成了56张完整的高密度图（心房n = 43；心室n = 11，冠状窦n = 2），平均有12,043±1,679个标测点。在7例手术（占手术的33%；检测到的心律失常范围为2 - 4种）中观察到多种心律失常。每次手术总共定义1 - 4个关键区域，并在16（四分位间距12 - 45）分钟内的射频应用时间内进行治疗。使用Lumipoint™的术后信号处理允许在特定感兴趣窗口内快速注释碎裂信号。这支持在27张完成的心房和心室心动过速激动图中的20张中识别出实用的关键峡部。
我们的研究结果表明，HDM联合新型自动注释算法可提供有关心律失常机制的详细见解，并可能有助于对具有中度至高度CHD复杂性的患者进行量身定制的导管消融。
