Nakatani Yosuke, Ramirez F Daniel, Takigawa Masateru, Nakashima Takashi, André Clémentine, Goujeau Cyril, Krisai Philipp, Takagi Takamitsu, Kamakura Tsukasa, Vlachos Konstantinos, Carapezzi Aline, Cheniti Ghassen, Tixier Romain, Welte Nicolas, Chauvel Remi, Duchateau Josselin, Pambrun Thomas, Derval Nicolas, Sacher Frédéric, Hocini Meleze, Haïssaguerre Michel, Jaïs Pierre
Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.).
IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.).
Circ Arrhythm Electrophysiol. 2023 Oct;16(10):e012241. doi: 10.1161/CIRCEP.123.012241. Epub 2023 Sep 20.
Abnormal atrial potentials (AAPs) recorded during sinus rhythm/atrial pacing may indicate areas of slow conduction capable of supporting reentrant atrial tachycardia (AT). Therefore, we sought to examine the relationship between AAPs and AT circuits.
One hundred twenty-three reentrant ATs in 104 patients were analyzed. AAPs, consisting of fragmented potentials and split potentials, were assessed using the Rhythmia LUMIPOINT algorithm.
There was 93±13% overlap between areas with AAPs during sinus rhythm/atrial pacing and areas of slow conduction along the reentry circuit during AT. The cumulative area of AAPs was smaller in patients with localized-reentrant ATs compared with anatomic macro-reentrant ATs (20.0 [14.6-30.5] versus 28.9 [21.8-35.6] cm; =0.021). Patients with perimitral ATs had larger areas of AAPs on the lateral wall whereas patients with roof-dependent ATs had larger areas of AAPs on the roof and posterior wall (≤0.018 for all comparisons). The patchy scar that was associated with localized-reentrant AT exhibited a larger area of AAPs at its periphery than the scar that did not participate in localized-reentrant AT (3.1 [2.4-4.5] versus 1.0 [0.7-1.6] cm; <0.001).
AAPs recorded during sinus rhythm/atrial pacing are associated with areas of slow conduction during reentrant AT. The burden and distribution of AAPs may provide actionable insights into AT circuit features, including in cases in which ATs are difficult to map.
在窦性心律/心房起搏期间记录到的异常心房电位（AAPs）可能提示存在能够支持折返性房性心动过速（AT）的缓慢传导区域。因此，我们试图研究AAPs与AT环路之间的关系。
对104例患者的123次折返性AT进行了分析。使用Rhythmia LUMIPOINT算法评估由碎裂电位和分裂电位组成的AAPs。
窦性心律/心房起搏期间出现AAPs的区域与AT期间折返环路中的缓慢传导区域之间存在93±13%的重叠。与解剖学大折返性AT相比，局灶性折返性AT患者的AAPs累积面积较小（20.0 [14.6 - 30.5] 平方厘米对28.9 [21.8 - 35.6] 平方厘米；P = 0.021）。二尖瓣周围AT患者在侧壁的AAPs面积较大，而依赖房顶的AT患者在房顶和后壁的AAPs面积较大（所有比较P≤0.018）。与局灶性折返性AT相关的片状瘢痕在其周边的AAPs面积大于未参与局灶性折返性AT的瘢痕（3.1 [2.4 - 4.5] 平方厘米对1.0 [0.7 - 1.6] 平方厘米；P < 0.001）。
窦性心律/心房起搏期间记录到的AAPs与折返性AT期间的缓慢传导区域相关。AAPs的负荷和分布可能为AT环路特征提供可操作的见解，包括在难以标测AT的情况下。
