Heart Center, Rhythm Management Division, Uji-Tokushukai Medical Center, Kyoto, Japan.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Cardiovasc Electrophysiol. 2020 Aug;31(8):1953-1963. doi: 10.1111/jce.14604. Epub 2020 Jun 22.
When performing linear ablation, creating contiguous and transmural lesions are technically challenging due to the difficulty in finding electrical conduction gaps. We hypothesized that high-density mapping could identify the gaps.
This study included consecutive patients who underwent conduction gap mapping of de novo lesions (41 patients, 55 lines) and previous lesions (25 patients, 34 lines). We analyzed the utility of bipolar and unipolar conduction gap mapping and retrospectively assessed the voltage and morphology of the bipolar electrograms at the gap sites. Bipolar and unipolar propagation maps were classified into three types: the propagation wavefront traveled through the linear ablation lesions (direct leak), the wavefront jumped to an opposite site across the line and returned to the line (jump and return leak), and others (indefinite leak). In the jump and return leak maps, the site where it returned suggested a conduction gap site. Bipolar propagation maps identified 30 (54.5%) conduction gaps and unipolar maps identified 40 (72.7%) gaps at de novo linear ablation lesions (P = .01), and 32 (94.1%) gaps and 33 (97.1%) gaps, respectively, at previous lesions (P = .56). Bipolar voltage mapping did not add any further efficacy in detecting conduction gaps, and the morphology of the electrograms recorded at the gap sites was not related to the types of propagation maps.
Conduction gaps of linear ablation lesions can be visualized by high-density mapping with a high probability. Unipolar propagation, when used with bipolar mapping, may help detect conduction gap sites.
在进行线性消融时，由于很难找到电传导间隙，因此创建连续且贯穿整个壁的病变是具有挑战性的。我们假设高密度标测可以识别这些间隙。
这项研究纳入了连续接受新发病变（41 例患者，55 条线）和既往病变（25 例患者，34 条线）的传导间隙标测的患者。我们分析了双极和单极传导间隙标测的效用，并回顾性评估了间隙部位双极电图的电压和形态。双极和单极传播图分为三种类型：线性消融病变内传播波阵面（直接渗漏）、波阵面穿过线跳到对面部位然后返回线（跳跃和返回渗漏）和其他（不确定渗漏）。在跳跃和返回渗漏图中，返回的部位提示为传导间隙部位。双极传播图在新发线性消融病变中识别出 30 个（54.5%）传导间隙，单极图识别出 40 个（72.7%）（P=0.01），在既往病变中分别识别出 32 个（94.1%）和 33 个（97.1%）（P=0.56）。双极电压标测并不能提高检测传导间隙的效果，记录在间隙部位的电图形态与传播图类型无关。
高密度标测可高概率可视化线性消融病变的传导间隙。双极图结合单极图可能有助于检测传导间隙部位。
