Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Ancona, Italy.
J Cardiovasc Electrophysiol. 2023 May;34(5):1216-1227. doi: 10.1111/jce.15908. Epub 2023 Apr 23.
The assessment of the ventricular myocardial substrate critically depends on the size of mapping electrodes, their orientation with respect to wavefront propagation, and interelectrode distance. We conducted a dual-center study to evaluate the impact of microelectrode mapping in patients undergoing catheter ablation (CA) of ventricular tachycardia (VT).
We included 21 consecutive patients (median age, 68 [12], 95% male) with structural heart disease undergoing CA for electrical storm (n = 14) or recurrent VT (n = 7) using the QDOT Micro catheter and a multipolar catheter (PentaRay, n = 9). The associations of peak-to-peak maximum standard bipolar (BV ) and minibipolar (PentaRay, BV ) with microbipolar (BV ) voltages were respectively tested in sinus rhythm with mixed effect models. Furthermore, we compared the features of standard bipolar (BE) and microbipolar (μBE) electrograms in sinus rhythm at sites of termination with radiofrequency energy.
BV was moderately associated with both BV (β = .85, p < .01) and BV (β = .56, p < .01). BV was 0.98 (95% CI: 0.93-1.04, p < .01) mV larger than corresponding BV , and 0.27 (95% CI: 0.16-0.37, p < .01) mV larger than matching BVp in sinus rhythm, with higher percentage differences in low voltage regions, leading to smaller endocardial dense scar (2.3 [2.7] vs. 12.1 [17] cm , p < .01) and border zone (3.2 [7.4] vs. 4.8 [20.1] cm , p = .03) regions in microbipolar maps compared to standard bipolar maps. Late potentials areas were nonsignificantly greater in microelectrode maps, compared to standard electrode maps. At sites of VT termination (n = 14), μBE were of higher amplitude (0.9 [0.8] vs. 0.4 [0.2] mV, p < .01), longer duration (117 [66] vs. 74 [38] ms, p < .01), and with greater number of peaks (4 [2] vs. 2 [1], p < .01) in sinus rhythm compared to BE.
microelectrode mapping is more sensitive than standard bipolar mapping in the identification of viable myocytes in SR, and may facilitate recognition of targets for CA.
心室心肌底物的评估主要取决于映射电极的大小、它们相对于波阵面传播的方向以及电极之间的距离。我们进行了一项双中心研究，以评估微电极映射在接受导管消融（CA）的室性心动过速（VT）患者中的影响。
我们纳入了 21 例连续患者（中位年龄 68 [12]，95%为男性），这些患者因电风暴（n=14）或复发性 VT（n=7）而行 CA，使用 QDOT 微导管和多极导管（PentaRay，n=9）。使用混合效应模型分别测试窦性心律下最大标准双极（BV）和微双极（PentaRay，BV）与微双极（BV）电压之间的峰值-峰值关联。此外，我们比较了在窦性心律下终止时与射频能量的标准双极（BE）和微双极（μBE）电图的特征。
BV与 BV（β=0.85，p<.01）和 BV（β=0.56，p<.01）均呈中度相关。BV比相应的 BV（β=0.98 [95%CI：0.93-1.04，p<.01]）大 0.98 mV，比匹配的 BVp 在窦性心律下大 0.27 mV（95%CI：0.16-0.37，p<.01），在低电压区域的百分比差异更大，导致微双极图中内皮层致密瘢痕（2.3 [2.7] vs. 12.1 [17] cm，p<.01）和交界区（3.2 [7.4] vs. 4.8 [20.1] cm，p=0.03）更小。与标准双极图相比，微电极图中的迟发电位区域无显著增大。在 VT 终止部位（n=14），μBE 在窦性心律下的振幅更高（0.9 [0.8] vs. 0.4 [0.2] mV，p<.01），持续时间更长（117 [66] vs. 74 [38] ms，p<.01），峰数更多（4 [2] vs. 2 [1]，p<.01）。
与标准双极图相比，微电极图在识别 SR 中存活心肌方面更敏感，可能有助于识别 CA 的靶点。
