Di Chengye, Wang Qun, Wu Yanxi, Li Longyu, Zhang Yan, Lin Wenhua
First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China.
College of Clinical Cardiology, Tianjin Medical University, Tianjin, China.
J Cardiovasc Electrophysiol. 2025 Jan;36(1):235-245. doi: 10.1111/jce.16503. Epub 2024 Nov 18.
Activation mapping for idiopathic ventricular arrhythmias (IVAs) typically relies on identifying the earliest bipolar electrograms and unipolar electrograms characterized by an initial QS morphology preceding the intrinsic deflection. However, the utility of unipolar electrogram morphology, particularly when associated with discrete pre-potentials, in guiding IVA mapping is not well understood.
We retrospectively analyzed 537 patients who underwent successful radiofrequency catheter ablation (RFCA) for IVAs between March 2016 and August 2023. Among them, 23 patients (4.3%) exhibited discrete bipolar pre-potentials with an isoelectric line between the end of the discrete pre-potential and the onset of the QRS complex during IVAs at the successful RFCA site. These cases were included in this study.
The time interval from the onset of the discrete pre-potential to the onset of the QRS complex was 66.4 ± 18.3 ms. The duration of the isoelectric line between the end of the discrete pre-potential and the onset of the QRS complex was 36.9 ± 13.6 ms. Unipolar electrograms associated with discrete pre-potentials exhibited an initial negative morphology in only 13 out of 23 patients (56.5%). In contrast, initial positive and isoelectric configurations in unipolar electrograms were observed in two patients (8.7%) and eight patients (34.8%), respectively. Perfect pace mapping was obtained in 21 patients (91.3%). RFCA was successful at the earliest site of the pre-potential within 3.5 ± 1.5 s in all 23 patients. During the 2.4 ± 1.2 years follow-up period, only one patient (4.3%) experienced a recurrence of clinical IVAs, with no complications reported during RFCA or follow-up.
Unipolar electrograms show limited reliability in guiding the identification of IVAs origins compared to bipolar electrograms associated with discrete pre-potentials.
特发性室性心律失常（IVA）的激动标测通常依赖于识别最早的双极电图和单极电图，其特征为在固有偏转之前出现初始QS形态。然而，单极电图形态在指导IVA标测中的作用，尤其是与离散前电位相关时，尚未得到充分理解。
我们回顾性分析了2016年3月至2023年8月期间因IVA接受成功射频导管消融（RFCA）的537例患者。其中，23例患者（4.3%）在成功RFCA部位的IVA期间，双极离散前电位与QRS波群起始之间存在等电位线。这些病例被纳入本研究。
从离散前电位起始到QRS波群起始的时间间隔为66.4±18.3毫秒。离散前电位结束与QRS波群起始之间的等电位线持续时间为36.9±13.6毫秒。与离散前电位相关的单极电图中，仅13例患者（56.5%）表现出初始负向形态。相比之下，分别在2例患者（8.7%）和8例患者（34.8%）中观察到单极电图的初始正向和等电位形态。21例患者（91.3%）获得了完美的起搏标测。所有23例患者在3.5±1.5秒内在前电位最早部位成功进行了RFCA。在2.4±1.2年的随访期内，仅1例患者（4.3%）出现临床IVA复发，RFCA或随访期间未报告并发症。
与与离散前电位相关的双极电图相比，单极电图在指导识别IVA起源方面的可靠性有限。
