Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan.
Europace. 2023 Dec 28;26(1). doi: 10.1093/europace/euad365.
The usefulness of coronary venous system mapping has been reported for assessing intramural and epicardial substrates in patients with scar-related ventricular tachycardia (VT). However, there has been little data on mapping from coronary arteries. We investigated the safety and utility of mapping from coronary arteries with a novel over-the-wire multielectrode catheter in scar-related VT patients.
Ten consecutive scar-related VT patients with non-ischaemic cardiomyopathy who underwent mapping from a coronary artery were analysed. Six patients underwent simultaneous coronary venous mapping. High-density maps were created by combining the left ventricular endocardium and coronary vessels. Substrate maps were created during the baseline rhythm with 2438 points (IQR 2136-3490 points), including 329 (IQR 59-508 points) in coronary arteries. Abnormal bipolar electrograms were successfully recorded within coronary arteries close to the endocardial substrate in seven patients. During VT, isthmus components were recorded within the coronary vessels in three patients with no discernible isthmus components on endocardial mapping. The ablation terminated the VT from an endocardial site opposite the earliest site in the coronary arteries in five patients.
The transcoronary mapping with an over-the-wire multielectrode catheter can safely record abnormal bipolar electrograms within coronary arteries. Additional mapping data from the coronary vessels have the potential to assess three-dimensional ventricular substrates and circuit structures in scar-related VT patients.
已有研究报道，冠状动脉静脉系统标测在评估与瘢痕相关的室性心动过速（VT）的心肌内和心外膜基质方面具有重要作用。然而，来自冠状动脉的标测数据较少。我们研究了一种新型的经导丝多电极导管从冠状动脉进行标测的安全性和实用性，该导管用于与瘢痕相关的 VT 患者。
分析了 10 例连续接受冠状动脉标测的非缺血性心肌病伴瘢痕相关 VT 的患者。6 例患者同时进行冠状动脉静脉标测。通过结合左心室心内膜和冠状动脉血管创建高密度图。在基线节律下使用 2438 个点（IQR 2136-3490 个点）创建基质图，包括冠状动脉内的 329 个点（IQR 59-508 个点）。7 例患者在冠状动脉内靠近心内膜基质的部位成功记录到异常双极电图。在 3 例 VT 期间，在冠状动脉内记录到峡部成分，而在心内膜标测上没有可识别的峡部成分。5 例患者的 VT 从冠状动脉内最早部位的对侧心内膜部位消融终止。
经导丝多电极导管的冠状动脉标测可安全记录冠状动脉内的异常双极电图。来自冠状动脉的额外标测数据有可能评估与瘢痕相关的 VT 患者的三维心室基质和回路结构。
