Department of Cardiac Electrophysiology, The Barts Heart Center, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
Department of Cardiac Electrophysiology, The Barts Heart Center, St. Bartholomew's Hospital, London, United Kingdom.
JACC Clin Electrophysiol. 2020 Dec;6(14):1783-1793. doi: 10.1016/j.jacep.2020.06.037. Epub 2020 Sep 16.
The goal of this study was to evaluate the role of dynamic substrate changes in facilitating conduction delay and re-entry in ventricular tachycardia (VT) circuits.
The presence of dynamic substrate changes facilitate functional block and re-entry in VT but are rarely studied as part of clinical VT mapping.
Thirty patients (age 67 ± 9 years; 27 male subjects) underwent ablation. Mapping was performed with the Advisor HD Grid multipolar catheter. A bipolar voltage map was obtained during sinus rhythm (SR) and right ventricular sense protocol (SP) single extra pacing. SR and SP maps of late potentials (LP) and local abnormal ventricular activity (LAVA) were made and compared with critical sites for ablation, defined as sites of best entrainment or pace mapping. Ablation was then performed to critical sites, and LP/LAVA identified by the SP.
At a median follow-up of 12 months, 90% of patients were free from antitachycardia pacing (ATP) or implantable cardioverter-defibrillator shocks. SP pacing resulted in a larger area of LP identified for ablation (19.3 mm vs. 6.4 mm) during SR mapping (p = 0.001), with a sensitivity of 87% and a specificity of 96%, compared with 78% and 65%, respectively, in SR.
LP and LAVA observed during the SP were able to identify regions critical for ablation in VT with a greater accuracy than SR mapping. This may improve substrate characterization in VT ablation. The combination of ablation to critical sites and SP-derived LP/LAVA requires further assessment in a randomized comparator study.
本研究旨在评估动态基质变化在促进室性心动过速（VT）回路传导延迟和折返中的作用。
动态基质变化的存在促进了 VT 中的功能性阻滞和折返，但作为 VT 临床标测的一部分很少被研究。
30 名患者（年龄 67 ± 9 岁；27 名男性）接受消融治疗。使用 Advisor HD Grid 多极导管进行标测。在窦性节律（SR）和右心室感知方案（SP）单步起搏时获得双极电压图。制作 SR 和 SP 晚期电位（LP）和局部异常心室活动（LAVA）图，并与消融的关键部位进行比较，定义为最佳夺获或起搏标测的部位。然后对关键部位进行消融，并根据 SP 识别 LP/LAVA。
在中位随访 12 个月时，90%的患者免于抗心动过速起搏（ATP）或植入式心脏复律除颤器电击。SP 起搏在 SR 标测时导致消融时 LP 识别的区域更大（19.3mm 比 6.4mm）（p=0.001），敏感性为 87%，特异性为 96%，而 SR 时分别为 78%和 65%。
与 SR 标测相比，SP 期间观察到的 LP 和 LAVA 能够更准确地识别 VT 消融的关键区域。这可能会改善 VT 消融中的基质特征。消融至关键部位和 SP 衍生的 LP/LAVA 的结合需要在随机对照研究中进一步评估。
