Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard-Thorndike Electrophysiology Institute, 185 Pilgrim Road, Baker 4, Boston, MA 02215, USA.
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Europace. 2020 Mar 1;22(3):440-449. doi: 10.1093/europace/euz364.
Multielectrode mapping catheters can be advantageous for identifying surviving myocardial bundles in scar. This study aimed to evaluate the utility of a new multielectrode catheter with increased number of small and closely spaced electrodes for mapping ventricles with healed infarction.
In 12 swine (four healthy and eight with infarction), the left ventricle was mapped with investigational (OctarayTM) and standard (PentarayTM) multielectrode mapping catheters. The investigational catheter has more electrodes (48 vs. 20), each with a smaller surface area (0.9 vs. 2.0 mm2) and spacing is fixed at 2 mm (vs. 2-6-2 mm). Electrogram (EGM) characteristics, mapping efficiency and scar description were compared between the catheters and late gadolinium enhancement (LGE). Electrogram acquisition rate was faster with the investigational catheter (814 ± 126 vs. 148 ± 58 EGM/min, P = 0.02) resulting in higher density maps (38 ± 10.3 vs. 10.1 ± 10.4 EGM/cm2, P = 0.02). Bipolar voltage amplitude was similar between the catheters in normal and infarcted myocardium (P = 0.265 and P = 0.44) and the infarct surface area was similar between the catheters (P = 0.12) and corresponded to subendocardial LGE. The investigational catheter identified a higher proportion of near-field local abnormal ventricular activities within the low-voltage area (53 ± 16% vs. 34 ± 16%, P = 0.03) that were considered far-field EGMs by the standard catheter. The investigational catheter was also advantageous for mapping haemodymically non-tolerated ventricular tachycardias due to its higher acquisition rate (P < 0.001).
A novel multielectrode mapping catheter with higher number of small, and closely spaced electrodes increases the mapping speed, EGM density and the ability to recognize low amplitude near-field EGMs in ventricles with healed infarction.
多电极标测导管在识别瘢痕中的存活心肌束方面具有优势。本研究旨在评估一种新型多电极导管的效用，该导管具有更多数量的小而紧密间隔的电极，用于标测愈合性梗死的心室。
在 12 头猪（4 头健康，8 头梗死）中，应用研究型（OctarayTM）和标准型（PentarayTM）多电极标测导管对左心室进行标测。研究型导管的电极数量更多（48 个 vs. 20 个），每个电极的表面积更小（0.9 vs. 2.0mm2），间距固定为 2mm（vs. 2-6-2mm）。比较了两种导管的心电图（EGM）特征、标测效率和瘢痕描述与晚期钆增强（LGE）的关系。研究型导管的 EGM 获取速度更快（814±126 比 148±58 个/分钟，P=0.02），因此生成的图密度更高（38±10.3 比 10.1±10.4 个/平方厘米，P=0.02）。正常和梗死心肌中两种导管的双极电压幅度相似（P=0.265 和 P=0.44），两种导管的梗死面积也相似（P=0.12），与心内膜下 LGE 相对应。研究型导管在识别低电压区的近场局部异常心室活动方面具有更高的比例（53±16%比 34±16%，P=0.03），而标准导管则认为这些活动是远场 EGM。由于研究型导管具有更高的获取速度，因此它在标测血液动力学不耐受性室性心动过速方面也具有优势（P<0.001）。
一种新型多电极标测导管，具有更多数量的小而紧密间隔的电极，可提高标测速度、EGM 密度以及识别愈合性梗死心室中低幅度近场 EGM 的能力。
