Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Pacing Clin Electrophysiol. 2024 Aug;47(8):1079-1086. doi: 10.1111/pace.15030. Epub 2024 Jun 21.
Identification of infrequent nonpulmonary vein trigger premature atrial contractions (PACs) is challenging. We hypothesized that pace mapping (PM) assessed by correlation scores calculated by an intracardiac pattern matching (ICPM) module was useful for locating PAC origins, and conducted a validation study to assess the accuracy of ICPM-guided PM.
Analyzed were 30 patients with atrial fibrillation. After pulmonary vein isolation, atrial pacing was performed at one or two of four sites on the anterior and posterior aspects of the left atrium (LA, n = 10/10), LA septum (n = 10), and lateral RA (n = 10), which was arbitrarily determined as PAC. The intracardiac activation obtained from each pacing was set as an ICPM reference consisting of six CS unipolar electrograms (CS group) or six CS unipolar electrograms and four RA electrograms (CS-RA group).
The PM was performed at 193 ± 107 sites for each reference pacing site. All reference pacing sites corresponded to sites where the maximal ICPM correlation score was obtained. Sites with a correlation score ≥98% were rarely obtained in the CS-RA than CS group (33% vs. 55%, P = .04), but those ≥95% were similarly obtained between the two groups (93% vs. 88%, P = .71), and those ≥90% were obtained in all. The surface areas with correlation scores ≥98% (0[0,10] vs. 10[0,35] mm, P = .02), ≥95% (10[10,30] vs. 50[10,180] mm, P = .002) and ≥90% (60[30,100] vs. 170[100,560] mm, P = .0002) were smaller in the CS-RA than CS group.
ICPM-guided PM was useful for identifying the reference pacing sites. Combined use of RA and CS electrograms may improve the mapping quality.
识别不常见的非肺静脉触发房性期前收缩（PACs）具有挑战性。我们假设通过心内模式匹配（ICPM）模块计算的相关评分进行起搏标测（PM）有助于定位 PAC 起源，并进行了一项验证研究以评估 ICPM 引导 PM 的准确性。
分析了 30 例心房颤动患者。在肺静脉隔离后，在左心房（LA）前后面的四个部位之一或两个部位（LA，n=10/10）、LA 间隔（n=10）和右侧 RA（n=10）进行心房起搏，这是任意确定的 PAC。从每个起搏获得的心内激活被设置为包含六个 CS 单极电图（CS 组）或六个 CS 单极电图和四个 RA 电图（CS-RA 组）的 ICPM 参考。
对于每个参考起搏部位，PM 进行了 193±107 次。所有参考起搏部位均对应于获得最大 ICPM 相关评分的部位。在 CS-RA 组中很少获得相关评分≥98%的部位（33%比 55%，P=0.04），但两组之间获得≥95%的部位相似（93%比 88%，P=0.71），且均获得≥90%的部位。获得≥98%相关评分的面积（0[0,10]比 10[0,35]mm，P=0.02）、≥95%相关评分的面积（10[10,30]比 50[10,180]mm，P=0.002）和≥90%相关评分的面积（60[30,100]比 170[100,560]mm，P=0.0002）在 CS-RA 组中小于 CS 组。
ICPM 引导的 PM 有助于识别参考起搏部位。RA 和 CS 电图的联合使用可能会提高映射质量。
