Kataoka Naoya, Imamura Teruhiko, Koi Takahisa, Uchida Keisuke, Kinugawa Koichiro
Second Department of Internal Medicine University of Toyama Toyama Toyama Japan.
J Arrhythm. 2025 Apr 15;41(2):e70070. doi: 10.1002/joa3.70070. eCollection 2025 Apr.
Ventricular tachycardias (VTs) associated with scar tissue involve reentry mechanisms influenced by both conduction abnormalities and repolarization heterogeneity. However, existing mapping techniques have predominantly focused on conduction delay.
This retrospective study analyzed 33 consecutive cases of catheter ablation for sustained VT. The EnSite system was employed to measure repolarization time (RT) with a high-pass filter setting of 0.05 Hz. We compared the characteristics and concordance rates of short RT areas, defined as white or red-colored regions, with those identified through conventional mappings in relation to ablation targets. These short RT areas were defined based on the longest interval from the QRS onset to the maximal / point of unipolar potentials, which was divided into eight equal segments.
Out of 31 VTs across 26 cases, we found that 18 (58%) of the identified ablation targets corresponded to deceleration zones (DZs). Of them, 16 (89%) also overlapped with areas of short RTs. Notably, among the remaining 13 VTs without ablation targets corresponding to DZs, 9 (69%) had ablation targets located in areas with short RTs. The distribution analysis revealed that 84% of short RT regions were located near the exit site, whereas 75% of DZs were situated near the entrance site. The distance between the two was 16 mm (interquartile range: 6.5-27.5 mm).
This study underscored the potential of RT mapping in identifying ablation targets in scar-related VTs. Incorporating both repolarization heterogeneity and conduction delay could significantly enhance the understanding of the intricate circuits involved in these arrhythmias.
与瘢痕组织相关的室性心动过速（VTs）涉及折返机制，受传导异常和复极异质性的影响。然而，现有的标测技术主要集中在传导延迟方面。
这项回顾性研究分析了33例连续的持续性VT导管消融病例。采用EnSite系统，高通滤波器设置为0.05Hz来测量复极时间（RT）。我们将定义为白色或红色区域的短RT区域的特征和符合率，与通过传统标测确定的与消融靶点相关的区域进行了比较。这些短RT区域是根据从QRS波起始到单极电位最大值/点的最长间期定义的，该间期被分为八个相等的部分。
在26例患者的31次VT中，我们发现18个（58%）已确定的消融靶点对应于减速区（DZs）。其中，16个（89%）也与短RT区域重叠。值得注意的是，在其余13次没有对应DZs的消融靶点的VT中，9个（69%）的消融靶点位于短RT区域。分布分析显示，84%的短RT区域位于出口部位附近，而75%的DZs位于入口部位附近。两者之间的距离为16mm（四分位间距：6.5 - 27.5mm）。
本研究强调了RT标测在识别瘢痕相关VT消融靶点方面的潜力。将复极异质性和传导延迟结合起来，可以显著增强对这些心律失常所涉及的复杂电路的理解。
