Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
J Interv Card Electrophysiol. 2023 Sep;66(6):1383-1389. doi: 10.1007/s10840-022-01435-2. Epub 2022 Dec 2.
Complex atrial tachyarrhythmias (CATs) are commonly observed in patients with prior catheter ablation or cardiac surgery. These arrhythmias are challenging to map and ablate. Historically, entrainment mapping was utilized to characterize CAT. With the advent of high-definition mapping (HDM), full visualization of the CAT circuit is possible which may obviate the need for entrainment mapping.
We sought to investigate the outcomes of catheter ablation of CAT guided only by HDM. Consecutive patients who underwent CAT ablation from 2017 to 2021 were included in our study (excluding right atrial tachyarrhythmias). Patients were sorted by the type of mapping performed. Group I consisted of patients where HDM alone was utilized with no attempt of entrainment. Group II consisted of patients where both entrainment and HDM were utilized.
A total of 67 patients were included in our study, with 40 patients in HDM group (I) and 27 patients in entrainment group (II). No statistically significant difference regarding 1-year freedom from atrial arrhythmias was found between the two groups (80% vs 77.8%, p = 0.819). Four CATs were terminated by entrainment during procedure versus none in the HDM-only group (p = 0.011).
CAT ablation with HDM alone yielded similar 1-year freedom from atrial arrhythmias compared to ablation with HDM and entrainment. Entrainment combined with HDM was associated with higher undesired CAT interruption rate. Further validation is needed with randomized control trials.
复杂的房性心动过速（CATs）在既往导管消融或心脏手术后的患者中很常见。这些心律失常的标测和消融具有挑战性。历史上，拖带标测用于对 CAT 进行特征描述。随着高清标测（HDM）的出现，可能不需要拖带标测就可以实现对 CAT 回路的全面可视化。
我们旨在研究仅使用 HDM 指导的导管消融治疗 CAT 的结果。我们的研究纳入了 2017 年至 2021 年期间接受 CAT 消融的连续患者（不包括右房性心动过速）。患者根据所进行的标测类型进行分类。第 I 组仅使用 HDM 进行标测，不尝试拖带。第 II 组患者同时使用拖带和 HDM 进行标测。
共有 67 例患者纳入本研究，HDM 组（I 组）40 例，拖带组（II 组）27 例。两组患者 1 年无房性心律失常的发生率无统计学差异（80%比 77.8%，p=0.819）。在 HDM 组中，有 4 例 CAT 在术中通过拖带终止，而在 HDM 组中无一例（p=0.011）。
与 HDM 联合拖带消融相比，仅使用 HDM 消融 CAT 的 1 年无房性心律失常的发生率相似。拖带联合 HDM 与更高的 CAT 中断率有关。需要进行随机对照试验进一步验证。
