Petzl Adrian, Benali Karim, Mbolamena Nicolas, Dyrda Katia, Rivard Léna, Seidl Sebastian, Martins Raphaël, Martinek Martin, Pürerfellner Helmut, Aguilar Martin
Electrophysiology Service, Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada.
Department of Cardiac Electrophysiology, Saint-Etienne University Hospital, France.
Heart Rhythm O2. 2024 Mar 21;5(4):234-242. doi: 10.1016/j.hroo.2024.03.006. eCollection 2024 Apr.
Cardiac radioablation is a new treatment for patients with refractory ventricular tachycardia (VT). The target for cardiac radioablation is subject to cardiorespiratory motion (CRM), the heart's movement with breathing and cardiac contraction. Data regarding the magnitude of target CRM are limited but are highly important for treatment planning.
The study sought to assess CRM amplitude by using ablation catheter geometrical data.
Electroanatomic mapping data of patients undergoing catheter ablation for VT at 3 academic centers were exported. The spatial position of the ablation catheter as a function of time while in contact with endocardium was analyzed and used to quantify CRM.
Forty-four patients with ischemic and nonischemic cardiomyopathy and VT contributed 1364 ablation lesions to the analysis. Average cardiac and respiratory excursion were 1.62 ± 1.21 mm and 12.12 ± 4.10 mm, respectively. The average ratio of respiratory to cardiac motion was approximately 11:1. CRM was greatest along the craniocaudal axis (9.66 ± 4.00 mm). Regional variations with respect to respiratory and cardiac motion were observed: basal segments had smaller displacements vs midventricular and apical segments. Patient characteristics (previous cardiac surgery, height, weight, body mass index, and left ventricular ejection fraction) had a statistically significant, albeit clinically moderate, impact on CRM.
CRM is primarily determined by respiratory displacement and is modulated by the location of the target and the patient's biometric characteristics. The patient-specific quantification of CRM may allow to decrease treatment volume and reduce radiation exposure of surrounding organs at risk while delivering the therapeutic dose to the target.
心脏射频消融术是治疗难治性室性心动过速（VT）患者的一种新方法。心脏射频消融术的靶点会受到心肺运动（CRM）的影响，即心脏随呼吸和心脏收缩的运动。关于靶点CRM幅度的数据有限，但对于治疗规划非常重要。
本研究旨在通过使用消融导管几何数据评估CRM幅度。
导出3个学术中心接受VT导管消融治疗患者的电解剖标测数据。分析消融导管与心内膜接触时作为时间函数的空间位置，并用于量化CRM。
44例患有缺血性和非缺血性心肌病及VT的患者为分析贡献了1364个消融灶。平均心脏和呼吸偏移分别为1.62±1.21毫米和12.12±4.10毫米。呼吸与心脏运动的平均比率约为11:1。CRM沿头尾轴最大（9.66±4.00毫米）。观察到呼吸和心脏运动的区域差异：基底节段的位移比心室中部和心尖节段小。患者特征（既往心脏手术、身高、体重、体重指数和左心室射血分数）对CRM有统计学上显著但临床上适度的影响。
CRM主要由呼吸位移决定，并受靶点位置和患者生物特征的调节。对CRM进行患者特异性量化可在将治疗剂量输送到靶点的同时，减少治疗体积并降低周围危险器官的辐射暴露。
