Ramsay Santé, Hôpital Privé Clairval, Service Cardiologie-Rythmologie, Marseille, France.
Departement of Cardiology, Pasteur University Hospital, Nice, France.
J Interv Card Electrophysiol. 2022 Jan;63(1):29-37. doi: 10.1007/s10840-021-00940-0. Epub 2021 Jan 27.
Diagnosis of atrial tachycardia (AT) with 3D mapping system remains challenging due to fibrosis or previous ablation. This study aims to evaluate a new electroanatomical mapping annotation setting using a window of interest adjusted at the end of the P wave (WOI) to identify the AT mechanism more accurately.
Twenty patients with successful ablation of left AT using navigation system CARTO3 were evaluated. Two maps for each patient were generated offline using either conventional settings of WOI (WOI) or WOI. Three investigators from two centres analysed the maps blindly.
Mechanisms of AT were macroreentrant in 14/20 patients (70%) and focal in 6/20 (30%). WOI resulted in a significant increase in the percentage of correct identification of the mechanism based on mapping alone (93.3 ± 13.7% vs 58.3 ± 33.9%; p = 0.0003) compared with WOI. Diagnoses based on mapping were arrived at faster (27.8 ± 16.4 s vs 38.97 ± 13.64 s, respectively; p = 0.0231) and with a greater confidence in the diagnosis (confidence index 2.57 ± 0.45 vs 2.12 ± 0.45, respectively; p = 0.0024). With perimitral re-entry specifically "early meets late" was closer to the anatomical region of the mitral isthmus (15.9 ± 20.9 mm vs 48.77 ± 23.23 mm, respectively; p = 0.0028).
This study found that electroanatomical mapping acquisition with a window of interest set at the end of the P wave improves the ability to diagnose the arrhythmia mechanism based on the initial map. It is particularly beneficial in identifying area of interest for ablation in perimitral AT.
由于纤维化或先前的消融，使用 3D 映射系统诊断房性心动过速（AT）仍然具有挑战性。本研究旨在评估一种新的电解剖映射注释设置，该设置使用在 P 波结束时调整的感兴趣窗口（WOI），以更准确地识别 AT 机制。
评估了 20 例使用导航系统 CARTO3 成功消融左房 AT 的患者。对每位患者生成了两个离线地图，分别使用常规 WOI（WOI）或 WOI 设置。来自两个中心的三位调查员进行了盲法分析。
AT 的机制在 20 例患者中有 14 例（70%）为大折返性，6 例（30%）为局灶性。WOI 显著提高了基于映射单独识别机制的准确性百分比（93.3±13.7%比 58.3±33.9%；p=0.0003）。基于映射的诊断更快（分别为 27.8±16.4 秒和 38.97±13.64 秒；p=0.0231），并且诊断的置信度更高（置信指数分别为 2.57±0.45 和 2.12±0.45；p=0.0024）。对于围绕二尖瓣峡部的周边折返性心动过速，特别是“早相遇晚”，更接近二尖瓣峡部的解剖区域（分别为 15.9±20.9 毫米和 48.77±23.23 毫米；p=0.0028）。
这项研究发现，在 P 波结束时设置感兴趣窗口的电解剖图采集可以提高根据初始图诊断心律失常机制的能力。它特别有利于识别周边 AT 消融的兴趣区域。
