Yvorel Cedric, Da Costa Antoine, Lerebours Chloe, Guichard Jean B, Viallon Gregory, Romeyer Cécile, Ferreira Thomas, Benali Karim, Isaaz Karl
Division of Cardiology, Jean Monnet University, Saint-Etienne, France.
J Cardiovasc Electrophysiol. 2021 Aug;32(8):2127-2139. doi: 10.1111/jce.15111. Epub 2021 Jun 3.
Only few studies have been performed that explore the electrophysiological differences between clockwise (CW) and counterclockwise (CCW) right atrial (RA) cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) using the high-resolution Rhythmia mapping system.
We sought to compare CW and CCW CTI-dependent AFL in pure right AFL patients (pts) using the ultra-high-definition (ultra-HD) Rhythmia mapping system and we mathematically developed a cartography model based on automatic velocity RA measurements to identify electrophysiological AFL specificities.
Thirty-three pts were recruited. The mean age was 71 ± 13 years old. The sinus venosus (SV) block line was present in 32/33 of cases (97%) and no significant difference was found between CCW and CW CTI AFL (100% vs. 91%; p = .7). No line was localized in the region of the crista terminalis (CT). A superior gap was present in the posterior line in 14/31 (45.2%) but this was similarly present in CCW AFL, when compared to CW AFL (10/22 [45.5%] vs. 4/10 [40%]; p = .9). When present, the extension of the posterior line of block was observed in 18/31 pts (58%) without significant differences between CCW and CW CI AFL (12/22 [54.5%] vs. 6/10 [60%]; p = .9) The Eustachian ridge line of block was similarly present in both groups (82% [18/22] vs. 45.5% [5/11]; p = .2). The absence of the Eustachian ridge line of block led to significantly slowed velocity in this area (28 ± 10 cm/s; n = 8), and the velocities were similarly altered between both groups (26 ± 10 [4/22] vs. 29.8 ± 11 cm/s [4/11]; p = .6). We created mathematical, three-dimensional RA reconstruction-velocity model measurements. In each block localization, when the block line was absent, velocity was significantly slowed (≤20 cm/s). A systematic slowdown in conduction velocity was observed at the entrance and exit of the CTI in 100% of cases. This alteration to the conduction entrance was localized at the lateral side of the CTI for the CCW AFL and at the septal side of the CTI for CW AFL. The exit-conduction alteration was localized at the CTI septal side for the CCW AFL and at the CTI lateral side for the CW AFL.
The ultra-HD Rhythmia mapping system confirmed the absence of significant electrophysiological differences between CCW and CW AFL. The mechanistic posterior SV and Eustachian ridge block lines were confirmed in each arrhythmia. A systematic slowing down at the entrance and exit of the CTI was demonstrated in both CCW and CW AFL, but in reverse positions.
仅有少数研究使用高分辨率Rhythmia标测系统探讨了顺时针（CW）和逆时针（CCW）右心房（RA）三尖瓣峡部（CTI）依赖性房扑（AFL）之间的电生理差异。
我们试图使用超高分辨率（ultra-HD）Rhythmia标测系统比较单纯右房AFL患者中CW和CCW CTI依赖性AFL，并通过数学方法基于自动RA速度测量建立一个标测模型，以识别AFL的电生理特异性。
招募了33例患者。平均年龄为71±13岁。32/33例（97%）存在窦房结（SV）阻滞线，CCW和CW CTI AFL之间无显著差异（100%对91%；p = 0.7）。没有阻滞线位于界嵴（CT）区域。14/31例（45.2%）后线存在上间隙，但与CW AFL相比，CCW AFL中同样存在该间隙（10/22 [45.5%]对4/10 [40%]；p = 0.9）。当存在时，18/31例患者（58%）观察到后阻滞线的延伸，CCW和CW CI AFL之间无显著差异（12/22 [54.5%]对6/10 [60%]；p = 0.9）。两组中均同样存在欧氏嵴阻滞线（82% [18/22]对45.5% [5/11]；p = 0.2）。欧氏嵴阻滞线的缺失导致该区域速度显著减慢（28±10 cm/s；n = 8），两组间速度变化相似（26±10 [4/22]对29.8±11 cm/s [4/11]；p = 0.6）。我们创建了数学三维RA重建速度模型测量。在每个阻滞定位中，当阻滞线不存在时，速度显著减慢（≤20 cm/s）。100%的病例中观察到CTI入口和出口处传导速度系统性减慢。CCW AFL的传导入口改变位于CTI外侧，CW AFL的传导入口改变位于CTI间隔侧。CCW AFL的出口传导改变位于CTI间隔侧，CW AFL的出口传导改变位于CTI外侧。
超高分辨率Rhythmia标测系统证实CCW和CW AFL之间无显著电生理差异。在每种心律失常中均证实了机制性的后SV和欧氏嵴阻滞线。CCW和CW AFL中均显示CTI入口和出口处系统性减慢，但位置相反。
