一种用于识别驱动灶的定量心电图分析新方法：对持续性心房颤动消融的启示
A novel approach for quantitative electrogram analysis for driver identification: Implications for ablation in persistent atrial fibrillation.
作者信息
Shi Wen-Rui, Wu Shao-Hui, Zou Guang-Chen, Xu Kai, Jiang Wei-Feng, Zhang Yu, Qin Mu, Liu Xu
机构信息
Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Internal Medicine, Danbury Hospital, Danbury, CT, United States.
出版信息
Front Cardiovasc Med. 2022 Dec 1;9:1049854. doi: 10.3389/fcvm.2022.1049854. eCollection 2022.
OBJECTIVE
This study sought to study the feasibility, efficacy, and safety of using multiscale entropy (MSE) analysis to guide catheter ablation for persistent atrial fibrillation (PsAF) and predict ablation outcomes.
METHODS
We prospectively enrolled 108 patients undergoing initial ablation for PsAF. MSE was calculated based on bipolar intracardiac electrograms (iEGMs) to measure the dynamical complexity of biological signals. The iEGMs data were exported after pulmonary vein isolation (PVI), then calculated in a customed platform, and finally re-annotated into the CARTO system. After PVI, regions of the highest mean MSE (mMSE) values were ablated in descending order until AF termination, or three areas had been ablated.
RESULTS
Baseline characteristics were evenly distributed between the AF termination ( = 38, 35.19%) and the non-termination group. The RA-to-LA mean MSE (mMSE) gradient demonstrated a positive gradient in the non-termination group and a negative gradient in the termination group (0.105 ± 0.180 vs. -0.235 ± 0.256, < 0.001). During a 12-month follow-up, 29 patients (26.9%) had arrhythmia recurrence after single ablation, and 18 of them had AF (62.1%). The termination group had lower rates of arrhythmia recurrence (15.79 vs. 32.86%, Log-Rank = 0.053) and AF recurrence (10.53 vs. 20%, Log-Rank = 0.173) after single ablation and a lower rate of arrhythmia recurrence (7.89 vs. 27.14%, Log-Rank = 0.018) after repeated ablation. Correspondingly, subjects with negative RA-to-LA mMSE gradient had lower incidences of arrhythmia (16.67 vs. 35%, Log-Rank = 0.028) and AF (16.67 vs. 35%, Log-Rank = 0.032) recurrence after single ablation and arrhythmia recurrence after repeated ablation (12.5 vs. 26.67%, Log-Rank = 0.062). Marginal peri-procedural safety outcomes were observed.
CONCLUSION
MSE analysis-guided driver ablation in addition to PVI for PsAF could be feasible, efficient, and safe. An RA < LA mMSE gradient before ablation could predict freedom from arrhythmia. The RA-LA MSE gradient could be useful for guiding ablation strategy selection.
目的
本研究旨在探讨使用多尺度熵（MSE）分析指导持续性心房颤动（PsAF）导管消融的可行性、有效性和安全性，并预测消融结果。
方法
我们前瞻性纳入了108例接受初次PsAF消融的患者。基于双极心内电图（iEGM）计算MSE，以测量生物信号的动态复杂性。iEGM数据在肺静脉隔离（PVI）后导出，然后在定制平台上计算，最后重新标注到CARTO系统中。PVI后，按降序对平均MSE（mMSE）值最高的区域进行消融，直至房颤终止，或已消融三个区域。
结果
房颤终止组（n = 38，35.19%）和未终止组的基线特征分布均匀。右心房（RA）至左心房（LA）的平均MSE（mMSE）梯度在未终止组呈正梯度，在终止组呈负梯度（0.105±0.180 vs. -0.235±0.256，P < 0.001）。在12个月的随访中，29例患者（26.9%）在单次消融后出现心律失常复发，其中18例为房颤（62.1%）。终止组在单次消融后心律失常复发率较低（15.79% vs. 32.86%，对数秩检验P = 0.053），房颤复发率较低（10.53% vs. 20%，对数秩检验P = 0.173），在重复消融后心律失常复发率也较低（7.89% vs. 27.14%，对数秩检验P = 0.018）。相应地，RA至LA mMSE梯度为负的受试者在单次消融后心律失常（16.67% vs. 35%，对数秩检验P = 0.028）和房颤（16.67% vs. 35%，对数秩检验P = 0.032）复发率较低，在重复消融后心律失常复发率也较低（12.5% vs. 26.67%，对数秩检验P = 0.062）。观察到边缘性围手术期安全结果。
结论
除PVI外，MSE分析指导的PsAF驱动灶消融可能是可行、有效和安全的。消融前RA < LA mMSE梯度可预测无心律失常。RA-LA MSE梯度可用于指导消融策略的选择。
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