Yagishita Atsuhiko, Sakama Susumu, Ayabe Kengo, Amino Mari, Ikari Yuji, Yoshioka Koichiro
Department of Cardiology, Tokai University, Kanagawa, Japan.
Int J Cardiol Heart Vasc. 2023 Mar 7;45:101193. doi: 10.1016/j.ijcha.2023.101193. eCollection 2023 Apr.
A novel mapping algorithm utilizing vectors and global patterns of propagation (Coherent™, Biosense Webster) has been developed to help identify the mechanism of atrial tachycardia (AT). We aimed to determine the diagnostic accuracy of coherent mapping compared with that of ripple mapping.
This study included 41 consecutive patients with 84 ATs (47 reentrant and 37 focal ATs). Two independent electrophysiologists confirmed the diagnoses using coherent mapping before the ripple map-guided ablation. AT termination was achieved in 75 of 84 ATs (89%) at first ablation lesion set. Four of the remaining nine ATs, which were terminated before an index radiofrequency (RF) application, were non-inducible after RF delivery at the first lesion set, whereas the other five ATs were terminated at the second lesion set. Diagnostic agreement between coherent and ripple maps was achieved in 51 of 84 ATs (61%): 28 of the 47 macroreentrant ATs (60%) and 23 of the 37 focal ATs (62%; P = 0.826). In typical macroreentrant ATs, including left atrial roof, perimitral, and cavotricuspid isthmus-dependent ATs, coherent maps achieved diagnostic agreement in 23 of 29 ATs (79%), which was higher than that in other ATs (51%, P = 0.018): 13 of 26 macroreentrant ATs (50%) and 15 of 29 focal ATs (52%, P = 1.000).
Ripple map-guided AT ablation achieved a high termination rate in the first lesion set. Coherent mapping yielded a favorable diagnostic accuracy for typical macroreentrant ATs, though its value for diagnosing other ATs was limited.
已开发出一种利用向量和整体传播模式的新型标测算法（Coherent™，Biosense Webster公司），以帮助识别房性心动过速（AT）的机制。我们旨在确定Coherent标测与涟漪标测相比的诊断准确性。
本研究纳入了41例连续患者的84次AT发作（47次折返性和37次局灶性AT）。两名独立的电生理学家在涟漪图引导的消融术前使用Coherent标测来确诊。在首次消融病灶组中，84次AT发作中的75次（89%）实现了AT终止。其余9次AT发作中有4次在首次应用索引射频（RF）前终止，在首次病灶组进行RF消融后不再诱发，而另外5次AT发作在第二次病灶组终止。84次AT发作中有51次（61%）在Coherent标测和涟漪图之间达成诊断一致：47次大折返性AT发作中有28次（60%），37次局灶性AT发作中有23次（62%；P = 0.826）。在典型的大折返性AT发作中，包括左心房顶部、二尖瓣周围和腔静脉-三尖瓣峡部依赖性AT发作，Coherent标测在29次AT发作中的23次（79%）达成诊断一致，高于其他AT发作（51%，P = 0.018）：26次大折返性AT发作中的13次（50%）和29次局灶性AT发作中的15次（52%，P = 1.000）。
涟漪图引导的AT消融在首次病灶组实现了较高的终止率。Coherent标测对典型大折返性AT发作具有良好的诊断准确性，但其对其他AT发作的诊断价值有限。
