Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, 210008, China.
Heart Vessels. 2021 Jul;36(7):1016-1026. doi: 10.1007/s00380-021-01772-8. Epub 2021 Jan 29.
Ripple mapping can make the visualization of activation conduction on a 3-dimensional voltage map and is useful tool for scar-related organized atrial tachycardia (AT). This study sought to assess the efficacy of ripple mapping for interpreting reentrant circuits and critical isthmus in postoperative ATs. 34 consecutive patients with a history of mitral valve surgery (mean age, 54.5 ± 12.4 years) underwent high density (HD) RM during ATs with CARTO3v4 CONFIDENSE system. The voltage activation threshold was determined by RM over a bipolar voltage map. The identification of underlying mechanisms and ablation setting was based on RM without reviewing activation mapping. A total of 41 ATs (35 spontaneous, 6 induced) were characterized. 39 reentry circuits were successfully mapped (cycle length, 256 ± 43 ms). Of the 41 ATs, 28 were confirmed by ripple mapping alone (68%), and 12 (29%) by ripple mapping and entrainment mapping. Of 12 ATs in the left atrium, 9 (75%) needed entrainment to confirm, compared with 5 (17.8%) in the right atrium. Primary endpoint after initial ablation set was achieved in 32 of the 34 patients (94.1%). Freedom from atrial arrhythmias was 79.4% after the follow-up of 12 ± 5 months. Of the seven patients with recurrence, three underwent the repeated catheter ablation. Ripple mapping precisely delineated reentrant circuits in post-cardiac surgery AT resulting in a high success rate of ablation. Entrainment maneuvers remain useful for elucidation of complex AT circuits.
纹波标测可使三维电压图上的激活传导可视化，是与瘢痕相关的有组织的房性心动过速（AT）的有用工具。本研究旨在评估纹波标测在解释术后 AT 折返环和关键峡部的有效性。34 例有二尖瓣手术史的连续患者（平均年龄 54.5±12.4 岁）在 CARTO3v4 CONFIDENSE 系统下接受高密度（HD）RM 治疗 AT。通过 RM 在双极电压图上确定电压激活阈值。潜在机制和消融设置的识别基于 RM 而不回顾激活图。共确定了 41 次 AT（35 次自发，6 次诱发）。39 个折返环成功定位（周长 256±43ms）。在 41 次 AT 中，仅纹波图可单独确定 28 次（68%），纹波图和拖带图可确定 12 次（29%）。在左心房的 12 次 AT 中，9 次（75%）需要拖带图来确认，而右心房的 5 次（17.8%）需要拖带图来确认。34 例患者中初始消融设定的主要终点在 32 例中达到（94.1%）。随访 12±5 个月后，无房性心律失常的比例为 79.4%。在 7 例复发患者中，3 例再次接受导管消融。纹波图精确描绘了心脏手术后 AT 的折返环，消融成功率高。拖带技术仍然有助于阐明复杂的 AT 环。
