Cen Zhifu, Yang Wenlong, Xie Zhonghui, Li Jiong, Cui Kaijun
Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, People's Republic of China.
Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, People's Republic of China.
J Electrocardiol. 2020 May-Jun;60:27-32. doi: 10.1016/j.jelectrocard.2019.11.039. Epub 2019 Nov 5.
Multi-electrode mapping (MEM) is increasingly applied in ablation of complex atrial arrhythmias. This study aimed to evaluate MEM for analysis and treatment of complex macroreentry atrial tachycardia (MAT).
Patients with MAT related to scarring, history of heart surgery or atrial linear ablation were studied. Patients were mapped with conventional activation mapping (CAM) or MEM. After characterizing the mechanism of atrial tachycardia (AT), the ablation was performed.
The study consisted of 114 eligible patients, 74 in the CAM and 40 in MEM. Compared with CAM, MEM had a shorter procedure duration (156.7 ± 59.1 ms vs. 127.3 ± 59.3 ms, P = 0.003) and mapping duration (62.6 ± 35.7 ms vs. 30.5 ± 15.3 ms, P < 0.001) and more mapping points (1364.9 ± 828.7 points vs. 148.3 ± 79.6 points, P < 0.001). There were no significant differences between CAM and MEM in acute ablation success rate, complication, postoperative AADs, and ablation duration. The mean disease-free survival time in CAM versus MEM was 20.8 (95% CI: 17.6-24.1) months versus 26.6 (95% CI: 22.7-30.4) months. The median disease-free survival time in the CAM versus MEM was 20.0 (95% CI: 13.9-26.1) months versus 30.0 (95% CI: 26.7-36.3) months. The AT recurrence risk of MEM was 0.522 times that of CAM (HR 95% CI: 0.282-0.968; P = 0.039).
MEM is strongly recommended in ablation of complex MAT.
多电极标测（MEM）在复杂房性心律失常的消融治疗中应用越来越广泛。本研究旨在评估MEM在分析和治疗复杂大折返性房性心动过速（MAT）中的作用。
对与瘢痕形成、心脏手术史或心房线性消融相关的MAT患者进行研究。患者采用传统激动标测（CAM）或MEM进行标测。在明确房性心动过速（AT）机制后，进行消融治疗。
该研究共纳入114例符合条件的患者，其中74例采用CAM，40例采用MEM。与CAM相比，MEM的手术时间更短（156.7±59.1毫秒对127.3±59.3毫秒，P = 0.003）、标测时间更短（62.6±35.7毫秒对30.5±15.3毫秒，P < 0.001）且标测点数更多（1364.9±828.7个点对148.3±79.6个点，P < 0.001）。CAM和MEM在急性消融成功率、并发症、术后抗心律失常药物（AADs）使用情况及消融时间方面无显著差异。CAM组与MEM组的平均无病生存时间分别为20.8（95%CI：17.6 - 24.1）个月和26.6（95%CI：22.7 - 30.4）个月。CAM组与MEM组的无病生存时间中位数分别为20.0（95%CI：13.9 - 26.1）个月和30.0（95%CI：26.7 - 36.3）个月。MEM的AT复发风险是CAM的0.522倍（HR 95%CI：0.282 - 0.968；P = 0.039）。
在复杂MAT的消融治疗中强烈推荐使用MEM。
