Nies Hedwig M J M, Linz Dominik, Bijvoet Geertruida P, Holtackers Robert J, Luermans Justin G L M, van der Velden Kim E H M, Wildberger Joachim E, Vernooy Kevin, van Kuijk Sander M J, Mihl Casper, Chaldoupi Sevasti-Maria
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
Heart Rhythm O2. 2024 Sep 6;5(11):778-787. doi: 10.1016/j.hroo.2024.08.015. eCollection 2024 Nov.
Cardiac magnetic resonance (CMR)-guided catheter ablation of the cavotricuspid isthmus (CTI) has been proven feasible, but determinants of local electrogram (EGM) voltage drops during radiofrequency (RF) applications are unknown.
The purpose of this study was to investigate local atrial bipolar EGM voltage drops and the association with delivered RF energy and anatomical information derived from peri-procedural CMR imaging.
In consecutive patients undergoing CMR-guided CTI ablation procedures, relative EGM voltage drops for RF applications ≥20 seconds were calculated. Pre- and post-ablation CMR imaging was performed. Associations of relative EGM voltage drops with patient characteristics, delivered RF energy, and CTI anatomy were analyzed.
In total, 216 RF applications were evaluated from 12 patients (18 ± 5 applications/patient). EGM voltage amplitude at baseline was significantly higher in the group with the strongest relative EGM voltage drop ( < .05), whereas RF ablation settings (duration, power, temperature) and lesion characteristics (impedance drop, slope of impedance drop) did not differ. The EGM voltage amplitude at baseline ( < .001), left ventricular ejection fraction (LVEF) ( = .020), right atrium volume index (RAVI) ( = .027), and CTI line length ( = .026) showed the strongest association with relative EGM voltage drop. Four of 12 patients (33%) underwent a re-do procedure, 2 patients showed a regional late reconnection, which could be visually identified in the T-weighted images (T2WI) of the index procedure.
Local EGM voltage amplitude, LVEF, RAVI, and CTI length are associated with relative EGM voltage drop during CMR-guided CTI ablation. Post-ablation CMR imaging during the index procedure may help to identify areas of late reconnection.
心脏磁共振（CMR）引导下三尖瓣峡部（CTI）导管消融已被证明可行，但射频（RF）应用期间局部心电图（EGM）电压下降的决定因素尚不清楚。
本研究旨在探讨局部心房双极EGM电压下降及其与传递的RF能量和围手术期CMR成像获得的解剖学信息之间的关联。
在连续接受CMR引导的CTI消融手术的患者中，计算持续时间≥20秒的RF应用的相对EGM电压下降。进行消融前和消融后的CMR成像。分析相对EGM电压下降与患者特征、传递的RF能量和CTI解剖结构之间的关联。
总共评估了12例患者的216次RF应用（每位患者18±5次应用）。相对EGM电压下降最强的组中，基线时的EGM电压幅度显著更高（<.05），而RF消融设置（持续时间、功率、温度）和病变特征（阻抗下降、阻抗下降斜率）无差异。基线时的EGM电压幅度（<.001）、左心室射血分数（LVEF）（=.020）、右心房容积指数（RAVI）（=.027）和CTI线长度（=.026）与相对EGM电压下降的关联最强。12例患者中有4例（33%）接受了再次手术，2例患者出现局部晚期重新连接，在初次手术的T加权图像（T2WI）中可直观识别。
在CMR引导的CTI消融过程中，局部EGM电压幅度、LVEF、RAVI和CTI长度与相对EGM电压下降相关。初次手术期间的消融后CMR成像可能有助于识别晚期重新连接的区域。
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