Kong Melissa H, Castellano Steven, Ruppersberg Peter, Lizama Ken S, Avitall Boaz
Ablacon, Inc., Wheat Ridge, CO, United States.
Deptartment of Medicine, University of Illinois at Chicago, Chicago, IL, United States.
Front Cardiovasc Med. 2023 Sep 1;10:1223481. doi: 10.3389/fcvm.2023.1223481. eCollection 2023.
Mapping algorithms have thus far been unable to localize triggers that serve as drivers of AF, but electrographic flow (EGF) mapping provides an innovative method of estimating and visualizing , near real-time cardiac wavefront propagation.
One-minute unipolar EGMs were recorded in the right atrium (RA) from a 64-electrode basket catheter to generate EGF maps during atrial rhythms of increasing complexity. They were obtained from 3 normal, animals in sinus rhythm (SR) and from 6 animals in which persistent AF which was induced by rapid atrial pacing. Concurrent EGF maps and high-resolution bipolar EGMs at the location of all EGF-identified sources were acquired. Pacing was subsequently conducted to create focal drivers of AF, and the accuracy of source detection at the pacing site was assessed during subthreshold, threshold and high-output pacing in the ipsilateral or contralateral atria ( = 78).
EGF recordings showed strong coherent flow emanating from the sinus node in SR that changed direction during pacing and were blocked by ablation lesions. Additional passive rotational phenomena and lower activity sources were visualized in atrial flutter (AFL) and AF. During the AF recordings, source activity was not found to be correlated to dominant frequency or wave amplitude observed in concurrently recorded EGMs. While pacing in AF, subthreshold pacing did not affect map properties but pacing at or above threshold created active sources that could be accurately localized without any spurious detection in 95% of cases of ipsilateral mapping when the basket covered the pacing source.
EGF mapping can be used to visualize flow patterns and accurately identify sources of AF in an animal model. Source activity was not correlated to spectral properties of f-waves in concurrently obtained EGMs. The locations of sources could be pinpointed with high precision, suggesting that they may serve as prime targets for focal ablations.
迄今为止，标测算法尚无法定位作为房颤驱动因素的触发灶，但电图血流（EGF）标测提供了一种估计和可视化近实时心脏波前传播的创新方法。
使用64电极篮状导管在右心房（RA）记录1分钟单极心内膜电图，以在心房节律逐渐复杂的过程中生成EGF图。这些图取自3只窦性心律（SR）的正常动物以及6只通过快速心房起搏诱发持续性房颤的动物。同时获取所有EGF识别源位置的EGF图和高分辨率双极心内膜电图。随后进行起搏以创建房颤的局灶性驱动因素，并在同侧或对侧心房（n = 78）的亚阈值、阈值和高输出起搏期间评估起搏部位源检测的准确性。
EGF记录显示，SR时窦房结发出强烈的相干血流，起搏时血流方向改变，并被消融灶阻断。在心房扑动（AFL）和房颤中还观察到了额外的被动旋转现象和较低活性的源。在房颤记录期间，未发现源活动与同时记录的心内膜电图中观察到的主导频率或f波振幅相关。在房颤起搏期间，亚阈值起搏不影响图的特性，但阈值或高于阈值的起搏会产生有源，当篮状导管覆盖起搏源时，在95%的同侧标测病例中可准确定位这些有源，且无任何假阳性检测。
EGF标测可用于在动物模型中可视化血流模式并准确识别房颤源。源活动与同时获得的心内膜电图中f波的频谱特性无关。源的位置可以高精度确定，表明它们可能是局灶性消融的主要靶点。
