Centre for Translational Electrophysiology, Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Electrophysiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.
Centre for Translational Electrophysiology, Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Biomedical Engineering, King's College London, London, United Kingdom.
JACC Clin Electrophysiol. 2024 Nov;10(11):2314-2324. doi: 10.1016/j.jacep.2024.07.028. Epub 2024 Oct 23.
In ventricular tachycardia (VT), optimal substrate mapping strategies identifying arrhythmogenic sites are not established.
This study sought to evaluate multidirectional pacing on the distribution of specific conduction and repolarization metrics to localize re-entrant VT sites in a porcine infarct model.
Substrate maps were created in 13 pigs with chronic myocardial infarction using the Advisor HD Grid (Abbott) during right ventricular (RV), left ventricular, biventricular pacing (BIV), and sinus rhythm (SR). Critical VT sites of early-, mid-, and late-diastolic signals were delineated. Vulnerable sites to re-entry were defined as sites of latest activation timing within and post-QRS complex, largest activation and activation-recovery interval gradients. Distances between the 20 most vulnerable sites and diastolic VT points were measured, and identification of VT points was assessed using the area under the receiver-operating characteristic curve.
A total of 34 VTs were mapped, and 48 sinus and pacing maps were obtained (10 BIV, 13 left ventricular, 13 RV, 12 SR). Late potential mapping in SR was taken as the established clinical standard for comparison. Latest activation time with BIV pacing provided the closest localization for VT isthmus (median 5.5 mm; IQR: 7.15 mm; P < 0.005). The gradient of activation-recovery interval using RV pacing had closest localization for VT exit and entrance (median 10.6 mm; IQR: 5.0 mm; P < 0.005 and 9.4 mm; IQR: 8.0 mm; P < 0.05). Global sensitivity and specificity analysis showed that gradient of activation-recovery interval in SR achieved the highest area under the receiver-operating characteristic curve, with similar results from the gradient of activation timing.
Multidirectional pacing in combination with conduction and repolarization parameters enables better localization of VT diastolic critical sites vs SR late potentials.
在室性心动过速（VT）中，尚未建立识别致心律失常部位的最佳底物映射策略。
本研究旨在评估多向起搏对特定传导和复极参数分布的影响，以定位猪梗死模型中的折返性 VT 部位。
在 13 头患有慢性心肌梗死的猪中，使用 Advisor HD Grid（雅培）在右心室（RV）、左心室、双心室起搏（BIV）和窦性节律（SR）下创建基质图。描绘早期、中期和舒张末期信号的关键 VT 部位。易发生折返的部位定义为 QRS 波群内和之后最晚激活的部位，以及最大激活和激活恢复间期梯度。测量 20 个最易损部位与舒张 VT 点之间的距离，并使用接受者操作特征曲线下的面积评估 VT 点的识别。
共映射了 34 个 VT，并获得了 48 个窦性和起搏图（10 个 BIV、13 个左心室、13 个 RV、12 个 SR）。SR 中的晚期电位映射被作为比较的既定临床标准。BIV 起搏时的最晚激活时间为 VT 峡部提供了最接近的定位（中位数 5.5mm；IQR：7.15mm；P<0.005）。RV 起搏时激活恢复间期梯度对 VT 出口和入口的定位最接近（中位数 10.6mm；IQR：5.0mm；P<0.005 和 9.4mm；IQR：8.0mm；P<0.05）。全局敏感性和特异性分析显示，SR 中的激活恢复间期梯度的曲线下面积最高，与激活时间梯度的结果相似。
与 SR 晚期电位相比，多向起搏结合传导和复极参数能更好地定位 VT 舒张期关键部位。
