Wakamatsu Yuji, Nagashima Koichi, Iso Kazuki, Sonoda Kazumasa, Watanabe Ryuta, Arai Masaru, Otsuka Naoto, Hayashida Satoshi, Yagyu Seina, Hirata Syu, Kurokawa Sayaka, Kimie Ohkubo, Nakai Toshiko, Okumura Yasuo
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
Kawaguchi Municipal Medical Center, 180 Nishiaraijyuku, Kawaguchi-shi, Saitama, 333-0833, Japan.
J Interv Card Electrophysiol. 2022 Jan;63(1):39-47. doi: 10.1007/s10840-020-00934-4. Epub 2021 Jan 29.
Entrainment is a useful method for locating reentrant atrial tachycardia (AT) circuits, but alterations or termination of the AT can derail this process. We assessed whether resetting an upstream site of a neighboring electrode by a scanned extrastimulus at a downstream site (when the upstream tissue was refractory) could diagnose that site within the AT circuit.
The procedure was applied to 48 ATs with a cycle length (CL) of 238 ± 42 ms (26 common flutters, 8 perimitral flutters, 7 left atrial [LA] roof-dependent AT, 3 LA scar-related macroreentrant ATs, 2 pulmonary vein-gap reentry tachycardias, 1 right atrial scar-related macroreentrant AT, and 1 with an unidentified circuit). Entrainment and scanned extrastimulation were attempted at the cavotricuspid isthmus, LA roof, and mitral isthmus and/or critical AT isthmus.
Within the circuit, the post-pacing interval minus the ATCL after entrainment was < 30 ms for all ATs and resetting of the AT cycle by ≥ 5 ms occurred in 94% of the ATs. No ATs were reset by extrastimulation outside the circuit. The positive predictive value of both maneuvers for locating the circuit was 100%, and the negative predictive value of the extrastimulation was similar to that of entrainment (96% vs. 100%, P = 0.25). The incidence of an AT alteration was lower with extrastimulation than with entrainment (1% vs. 9%, P = 0.01). For ATs with a CL < 210 ms, extrastimulation yielded a good diagnostic performance without any AT alterations.
AT resetting by a scanned extrastimulus is diagnostic and avoids AT alterations.
拖带是定位折返性房性心动过速（AT）环路的一种有用方法，但AT的改变或终止可能会干扰这一过程。我们评估了当下游部位的扫描期外刺激使相邻电极的上游部位复位（当上游组织处于不应期时）是否能够诊断AT环路中的该部位。
该方法应用于48例AT患者，其心动周期长度（CL）为238±42 ms（26例常见房扑、8例二尖瓣环周房扑、7例左心房[LA]顶部依赖型AT、3例LA瘢痕相关大折返性AT、2例肺静脉-间隙折返性心动过速、1例右心房瘢痕相关大折返性AT以及1例环路不明的AT）。尝试在三尖瓣峡部、LA顶部和二尖瓣峡部和/或关键AT峡部进行拖带和扫描期外刺激。
在环路内，所有AT在拖带后起搏后间期减去ATCL均<30 ms，94%的AT其AT周期复位≥5 ms。环路外的期外刺激未使任何AT复位。两种操作定位环路的阳性预测值均为100%，期外刺激的阴性预测值与拖带相似（96%对100%，P = 0.25）。期外刺激导致AT改变的发生率低于拖带（1%对9%，P = 0.01）。对于CL<210 ms的AT，期外刺激具有良好的诊断性能且未出现任何AT改变。
通过扫描期外刺激进行AT复位具有诊断价值且可避免AT改变。
