Barkagan Michael, Brem Ofir, Younis Arwa, Bubar Zachary P, Yarnitsky Jonathan, Milman Anat, Zabern Maxime, Vasilenko Vladimir, Yadin Dor, Anter Elad
Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Shamir Medical Center, Be'er Yaakov, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
JACC Clin Electrophysiol. 2025 Jun;11(6):1132-1141. doi: 10.1016/j.jacep.2025.01.018. Epub 2025 Mar 26.
There is an ongoing effort to develop catheters with closer interelectrode spacing to improve mapping resolution. However, the optimal distance for mapping postinfarct scar has yet to be established.
This study sought to assess the effect of interelectrode distance on ventricular scar electrograms.
In 8 swine with healed myocardial infarction, the left ventricle was mapped using an experimental 48-electrode array with a 1.2 mm center-to-center distance. Additional maps with 2.4, 3.6, and 4.8 mm distances were created using nonadjacent electrodes. The impact of interelectrode distance on voltage amplitude and near-field (NF) and far-field (FF) activity relationships was analyzed.
At a 1.2 mm interelectrode distance, voltage amplitudes <1.5 mV accurately correlated with the endocardial infarct surface area, while increasing the distance to 4.8 mm progressively overestimated the infarct area (P < 0.001). However, adjusting voltage cutoffs for each interelectrode distance restored the correlation to the actual infarct size. The primary distinction between distances was the ability to differentiate NF from FF potentials. At 4.8 mm and 3.6 mm, FF potential amplitude often exceeded NF amplitude (NF/FF ratios of 0.8 ± 0.3 and 0.9 ± 0.2, respectively). Reducing the distance to 2.4 mm attenuated FF potentials, yielding an NF/FF ratio of 1.2 ± 0.4. Further reduction to 1.2 mm showed no significant additional effect (NF/FF ratio 1.3 ± 0.3; P = 0.09).
Bipoles with a 2 mm interelectrode distance most effectively match endocardial scar tissue and attenuate NF potentials. These benefits plateau at 2 mm, suggesting that it may represent the optimal distance for delineating postinfarction substrates.
目前正在努力开发电极间距更近的导管，以提高标测分辨率。然而，用于梗死灶后瘢痕标测的最佳距离尚未确定。
本研究旨在评估电极间距对心室瘢痕电图的影响。
在8只心肌梗死已愈合的猪中，使用中心间距为1.2毫米的实验性48电极阵列对左心室进行标测。使用不相邻电极创建了间距为2.4、3.6和4.8毫米的额外标测图。分析了电极间距对电压幅度以及近场（NF）和远场（FF）活动关系的影响。
在电极间距为为1.2毫米时，电压幅度<1.5毫伏与心内膜梗死面积准确相关，而将间距增加到4.8毫米会逐渐高估梗死面积（P<0.001）。然而，针对每个电极间距调整电压截断值可恢复与实际梗死大小的相关性。不同间距之间的主要区别在于区分NF和FF电位的能力。在4.8毫米和3.6毫米时，FF电位幅度常常超过NF幅度（NF/FF比值分别为0.8±0.3和0.9±0.2）。将间距减小到2.4毫米会减弱FF电位，NF/FF比值为1.2±0.4。进一步减小到1.2毫米未显示出显著的额外效果（NF/FF比值为1.3±0.3；P=0.09）。
电极间距为2毫米的双极电极最有效地匹配心内膜瘢痕组织并减弱NF电位。这些益处在2毫米时趋于平稳，表明这可能是描绘梗死后期基质的最佳距离。
