Cardiology Division, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
Europace. 2021 Apr 6;23(4):624-633. doi: 10.1093/europace/euaa300.
During entrainment mapping of macro-reentrant tachycardias, the time difference (dPPI) between post-pacing interval (PPI) and tachycardia cycle length (TCL) is thought to be a function of the distance of the pacing site to the re-entry circuit and dPPI < 30 ms is considered within the re-entry circuit. This study assessed the importance of PPI < TCL as a successful target for atypical flutter ablation.
A total of 177 ablation procedures were investigated. Surface electrocardiograms (ECGs) were evaluated and combined activation and entrainment mapping were performed to choose ablation sites. Each entrainment sequence immediately preceding static radiofrequency delivery at the same site was analysed. A total of 545 entrainment sequences were analysed. dPPI < 0 ms was observed in 45.3% (247/545) sequences. Ablation resulted in tachycardia termination more often at sites with dPPI < 0 (27.8% vs. 14.5%, P < 0.001) and with a progressively increasingly inverse correlation between dPPI duration and ablation success [odds ratio (OR): 0.974; 95% confidence interval (CI) 0.960-0.988; P < 0.001]. Tachycardia termination or cycle length prolongation also occurred more often at sites with dPPI < 0 (50.6% vs. 33.2%, P < 0.001) and with a similar inverse correlation with dPPI duration (OR: 0.972; 95% CI 0.960-0.984; P < 0.001). Twelve-lead synchronous isoelectric intervals were observed in 64.4% (163/253) flutter ECGs and were associated with a dPPI < 0 (75.3% vs. 55.8%, P < 0.001).
When combined with activation mapping, a negative dPPI is a more effective parameter for identifying a target for successful ablation compared to a dPPI = 0-30 ms. Its occurrence is associated with a critical small narrow slow-conducting isthmus at the target site.
在宏观折返性心动过速的夺获标测中，起搏后间期（PPI）与心动过速周长（TCL）之间的时间差（dPPI）被认为是起搏部位与折返环之间距离的函数，而 dPPI<30ms 被认为位于折返环内。本研究评估了 PPI<TCL 作为非典型房扑消融的成功靶点的重要性。
共分析了 177 例消融手术。评估体表心电图（ECG）并进行激动和夺获标测以选择消融部位。对同一部位进行静态射频消融前的每个夺获序列进行分析。共分析了 545 个夺获序列。45.3%（247/545）的序列中观察到 dPPI<0ms。dPPI<0 时消融更常导致心动过速终止（27.8%比 14.5%，P<0.001），且 dPPI 持续时间与消融成功率之间呈逐渐增强的反比关系[比值比（OR）：0.974；95%置信区间（CI）0.960-0.988；P<0.001]。dPPI<0 时心动过速终止或周期长度延长也更常见（50.6%比 33.2%，P<0.001），且与 dPPI 持续时间呈相似的反比关系（OR：0.972；95%CI 0.960-0.984；P<0.001）。12 导联同步等电间期见于 64.4%（163/253）的房扑 ECG 中，与 dPPI<0 相关（75.3%比 55.8%，P<0.001）。
与 dPPI=0-30ms 相比，当与激动标测结合时，负性 dPPI 是识别成功消融靶点的更有效参数。其发生与靶点处临界的小而窄的慢传导峡部有关。
