Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain; INSERM, SAINBIOSE U1059, University Hospital of Saint-Étienne, Saint-Étienne, France; Cardiology Department, University Hospital of Saint-Étienne, Saint-Étienne, France.
Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
JACC Clin Electrophysiol. 2024 Jul;10(7 Pt 2):1534-1547. doi: 10.1016/j.jacep.2024.04.023. Epub 2024 May 16.
A partial delineation of targets for ablation of ventricular tachycardia (VT) during a stable rhythm is likely responsible for a suboptimal success rate. The abnormal low-voltage near-field functional components may be hidden within the high-amplitude far-field signal.
The aim of this study was to evaluate the benefit and feasibility of functional substrate mapping using a full-ventricle S3 protocol and to assess its colocalization with arrhythmogenic conducting channels (CCs) on late gadolinium enhancement cardiac magnetic resonance.
An S3 mapping protocol with a drive train of S1 followed by S2 (effective refractory period + 30 ms) and S3 (effective refractory period + 50 ms) from the right ventricular apex was performed in 40 consecutive patients undergoing scar-related VT ablation. Deceleration zones (DZs) and areas of late potentials (LPs) were identified for all maps. A preprocedural noninvasive substrate assessment was done using late gadolinium enhancement cardiac magnetic resonance and postprocessing with automated CC identification.
The S3 protocol was completed in 34 of the 40 procedures (85.0%). The S3 protocol enhanced the identification of VT isthmus on the basis of DZ (89% vs 62%; P < 0.01) and LP (93% vs 78%; P = 0.04) assessment. The percentage of CCs unmasked by DZs and LPs using S3 maps was significantly higher than the ones using S2 and S1 maps (78%, 65%, and 48% [P < 0.001] and 88%, 81%, and 68% [P < 0.01], respectively). The functional substrate identified during S3 activation mapping was significantly more extensive than the one identified using S2 and S1, including a greater number of DZs (2.94, 2.47, and 1.82, respectively; P < 0.001) and a wider area of LPs (44.1, 38.2, and 29.4 cm, respectively; P < 0.001). After VT ablation, 77.9% of patients have been VT free during a median follow-up period of 13.6 months.
The S3 protocol was feasible in 85% of patients, allows a better identification of targets for ablation, and might improve VT ablation results.
在稳定节律期间，对室性心动过速（VT）消融靶点的部分描绘可能导致消融成功率不理想。异常的低电压近场功能成分可能隐藏在高振幅远场信号中。
本研究旨在评估使用全心室 S3 方案进行功能基质标测的益处和可行性，并评估其与晚期钆增强心脏磁共振上致心律失常传导通道（CC）的局部化。
对 40 例连续进行瘢痕相关 VT 消融的患者进行了从右心室心尖开始的 S1 后继 S2（有效不应期+30ms）和 S3（有效不应期+50ms）的 S3 映射方案。为所有图谱识别减速区（DZ）和晚期电位（LP）区域。使用晚期钆增强心脏磁共振进行术前非侵入性基质评估，并使用自动 CC 识别进行后处理。
在 40 例手术中有 34 例（85.0%）完成了 S3 方案。S3 方案基于 DZ（89%比 62%；P<0.01）和 LP（93%比 78%；P=0.04）评估，增强了 VT 峡部的识别。使用 S3 图谱揭示的 CC 百分比显著高于使用 S2 和 S1 图谱的百分比（78%、65%和 48%[P<0.001]和 88%、81%和 68%[P<0.01]）。S3 激活映射中识别的功能基质明显比使用 S2 和 S1 识别的基质广泛，包括更多的 DZ（2.94、2.47 和 1.82，分别；P<0.001）和更大面积的 LP（44.1、38.2 和 29.4cm，分别；P<0.001）。在 VT 消融后，77.9%的患者在中位 13.6 个月的随访期间无 VT。
S3 方案在 85%的患者中是可行的，允许更好地识别消融靶点，并可能改善 VT 消融的结果。
