Wang Linlin, Ding Xiangwei, Ju Weizhu, Chen Hongwu, Gu Kai, Li Mingfang, Chen Minglong, Yang Gang
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Department of Cardiology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, China.
J Interv Card Electrophysiol. 2024 Sep 12. doi: 10.1007/s10840-024-01911-x.
The heterogeneous conduction properties through the cavotricuspid isthmus (CTI) in typical atrial flutter (AFL) have not yet been well elucidated.
We sought to investigate preferential conduction through the CTI and the efficacy of ablation targeting preferential wavefront (PW) guided by ultra-high-resolution mapping.
In retrospective study, 28 patients were enrolled. Wavefront propagation patterns through the CTI and ablation responses at the location of PW were evaluated. In the following prospective study, 23 patients with predominant PW across the CTI were enrolled and assigned to the arm of PW prior ablation and the arm of conventional ablation.
Five activation patterns were noticed in the retrospective study. The termination sites were exactly located at the PW in 18 of 28 patients (64.3%). The width of the PW in direct termination group was significantly narrower than that in the CL prolongation before termination group (16.6 ± 1.0 mm vs. 23.3 ± 3.4 mm, respectively, p = 0.025). In the prospective study, the voltage of PW region was significantly higher than non-PW regions both from unipolar and bipolar mapping. 21 of 23 patients (91.3%) were terminated at PW. AFL could no longer be induced immediately after termination. The time from radiofrequency application to AFL termination and to achieve bidirectional conduction block was significantly shorter in PW prior ablation arm than that in conventional ablation group (p < 0.05).
Ablation targeting the PW first could be more efficient to terminate typical AFL and to achieve the endpoint of bidirectional conduction block.
典型心房扑动（AFL）中通过腔静脉三尖瓣峡部（CTI）的异质传导特性尚未得到充分阐明。
我们试图研究通过CTI的优先传导以及超高分辨率标测引导下针对优先波前（PW）消融的疗效。
在回顾性研究中，纳入了28例患者。评估了通过CTI的波前传播模式以及PW部位的消融反应。在接下来的前瞻性研究中，纳入了23例CTI上以PW为主的患者，并将其分为PW预消融组和传统消融组。
回顾性研究中发现了五种激动模式。28例患者中有18例（64.3%）的终止部位恰好位于PW处。直接终止组的PW宽度明显窄于终止前CL延长组（分别为16.6±1.0mm和23.3±3.4mm，p = 0.025）。在前瞻性研究中，无论是单极还是双极标测，PW区域的电压均明显高于非PW区域。23例患者中有21例（91.3%）在PW处终止。终止后立即不能再诱发AFL。PW预消融组从射频施加到AFL终止以及实现双向传导阻滞的时间明显短于传统消融组（p < 0.05）。
首先针对PW进行消融可能更有效地终止典型AFL并实现双向传导阻滞的终点。
