详细分析心动过速周期长度有助于诊断房性心动过速的机制和位置。
Detailed analysis of tachycardia cycle length aids diagnosis of the mechanism and location of atrial tachycardias.
机构信息
Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France.
IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France.
出版信息
Europace. 2023 Aug 2;25(9). doi: 10.1093/europace/euad195.
AIMS
Although the mechanism of an atrial tachycardia (AT) can usually be elucidated using modern high-resolution mapping systems, it would be helpful if the AT mechanism and circuit could be predicted before initiating mapping.
OBJECTIVE
We examined if the information gathered from the cycle length (CL) of the tachycardia can help predict the AT-mechanism and its localization.
METHODS
One hundred and thirty-eight activation maps of ATs including eight focal-ATs, 94 macroreentrant-ATs, and 36 localized-ATs in 95 patients were retrospectively reviewed. Maximal CL (MCL) and minimal CL (mCL) over a minute period were measured via a decapolar catheter in the coronary sinus. CL-variation and beat-by-beat CL-alternation were examined. Additionally, the CL-respiration correlation was analysed by the RhythmiaTM system. : Both MCL and mCL were significantly shorter in macroreentrant-ATs [MCL = 288 (253-348) ms, P = 0.0001; mCL = 283 (243-341) ms, P = 0.0012], and also shorter in localized-ATs [MCL = 314 (261-349) ms, P = 0.0016; mCL = 295 (248-340) ms, P = 0.0047] compared to focal-ATs [MCL = 506 (421-555) ms, mCL = 427 (347-508) ms]. An absolute CL-variation (MCL-mCL) < 24 ms significantly differentiated re-entrant ATs from focal-ATs with a sensitivity = 96.9%, specificity = 100%, positive predictive value (PPV) = 100%, and negative predictive value (NPV) = 66.7%. The beat-by-beat CL-alternation was observed in 10/138 (7.2%), all of which showed the re-entrant mechanism, meaning that beat-by-beat CL-alternation was the strong sign of re-entrant mechanism (PPV = 100%). Although the CL-respiration correlation was observed in 28/138 (20.3%) of ATs, this was predominantly in right-atrium (RA)-ATs (24/41, 85.7%), rather than left atrium (LA)-ATs (4/97, 4.1%). A positive CL-respiration correlation highly predicted RA-ATs (PPV = 85.7%), and negative CL-respiration correlation probably suggested LA-ATs (NPV = 84.5%).
CONCLUSION
Detailed analysis of the tachycardia CL helps predict the AT-mechanism and the active AT chamber before an initial mapping.
目的
尽管现代高分辨率标测系统通常可以阐明房性心动过速（AT）的机制，但如果能在开始标测之前预测 AT 机制及其回路，将很有帮助。
目的
我们研究了心动过速的心动周期（CL）信息是否有助于预测 AT 机制及其定位。
方法
回顾了 95 例患者 138 个 AT 的激活图，包括 8 个局灶性 AT、94 个大折返性 AT 和 36 个局限性 AT。通过冠状窦内的十极导管测量一分钟内的最大 CL（MCL）和最小 CL（mCL）。检查 CL 变化和逐搏 CL 交替。此外，使用 RhythmiaTM 系统分析 CL 与呼吸的相关性。结果：大折返性 AT 的 MCL 和 mCL 均明显缩短[MCL=288（253-348）ms，P=0.0001；mCL=283（243-341）ms，P=0.0012]，局限性 AT 的 MCL 和 mCL 也缩短[MCL=314（261-349）ms，P=0.0016；mCL=295（248-340）ms，P=0.0047]，与局灶性 AT 的 MCL（506（421-555）ms，mCL（427（347-508）ms）相比。绝对 CL 变化（MCL-mCL）<24 ms 可显著区分折返性 AT 与局灶性 AT，其敏感性=96.9%，特异性=100%，阳性预测值（PPV）=100%，阴性预测值（NPV）=66.7%。138 例中观察到 10/138（7.2%）例出现逐搏 CL 交替，均表现为折返性机制，即逐搏 CL 交替是折返性机制的强烈标志（PPV=100%）。尽管在 138 例 AT 中观察到 28/138（20.3%）例 CL 与呼吸相关，但这主要发生在右心房（RA）-AT（24/41，85.7%），而不是左心房（LA）-AT（4/97，4.1%）。阳性 CL 与呼吸相关高度预测 RA-AT（PPV=85.7%），阴性 CL 与呼吸相关可能提示 LA-AT（NPV=84.5%）。
结论
在进行初始标测之前，详细分析心动过速的 CL 有助于预测 AT 机制和活动的 AT 腔室。
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