Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
Heart Rhythm. 2024 Aug;21(8):1298-1307. doi: 10.1016/j.hrthm.2024.02.060. Epub 2024 Mar 1.
A rotational activation pattern (RAP) around the localized line of a conduction block often correlates with sites specific to the critical zones of ventricular tachycardia (VT). The wavefront direction during substrate mapping affects manifestation of the RAP and line of block.
The purpose of this study was to investigate the most optimal cardiac rhythm for identifying RAP and line of block in substrate mapping.
We retrospectively evaluated 71 maps (median 3205 points/map) in 46 patients (65 ± 15 years; 33% with ischemic cardiomyopathy) who underwent high-density substrate mapping and ablation of scar-related VT. Appearance of a RAP during sinus, right ventricular (RV)-paced, left ventricular (LV)-paced, and biventricular-paced rhythms was investigated.
RAP was identified in 24 of 71 maps (34%) in the region where wavefronts from a single direction reached but not in the region where wavefronts from multiple directions centripetally collided. The probability of identifying the RAP depended on scar location; that is, anteroseptal and inferoseptal, inferior and apical, and basal lateral RAPs were likely to be identified during sinus/atrial, RV-paced, and LV-paced rhythms, respectively. In 13 patients, the RAP was not evident in the baseline map but became apparent during remapping in the other rhythm, in which the wavefront reached the site earlier within the entire activation time.
The optimal rhythm for substrate mapping depends on the spatial distribution of the area of interest. A paced rhythm with pacing sites near the scar may facilitate the identification of critical VT zones.
在传导阻滞的局灶线上的旋转激活模式（RAP）常与室性心动过速（VT）的关键区域特定部位相关。基质标测时的波阵面方向会影响 RAP 和阻滞线的表现。
本研究旨在探讨在基质标测中识别 RAP 和阻滞线的最佳心脏节律。
我们回顾性评估了 46 例患者（65±15 岁；33%为缺血性心肌病）的 71 张图（中位数 3205 个点/图），这些患者均接受了高密度基质标测和瘢痕相关 VT 的消融。研究了窦性心律、右心室（RV）起搏、左心室（LV）起搏和双心室起搏心律中 RAP 的出现情况。
在 71 张图中有 24 张（34%）的区域中可识别 RAP，而在多个方向向心碰撞的区域中则无法识别 RAP。识别 RAP 的概率取决于瘢痕的位置；即前间隔和下间隔、下壁和心尖部以及基底侧壁的 RAP 分别在窦性/房性、RV 起搏和 LV 起搏节律中更有可能被识别。在 13 例患者中，RAP 在基线图中不明显，但在另一种节律的重新标测中变得明显，其中波阵面在整个激活时间内更早到达该部位。
基质标测的最佳节律取决于感兴趣区域的空间分布。起搏部位靠近瘢痕的起搏节律可能有助于识别关键 VT 区域。
