Marchlinski F, Callans D, Gottlieb C, Rodriguez E, Coyne R, Kleinman D
Electrophysiology Section, Allegheny University Hospitals, Philadelphia, PA 19102, USA.
Pacing Clin Electrophysiol. 1998 Aug;21(8):1621-35. doi: 10.1111/j.1540-8159.1998.tb00252.x.
Uniform success for ablation of focal atrial tachycardias has been difficult to achieve using standard catheter mapping and ablation techniques. In addition, our understanding of the complex relationship between atrial anatomy, electrophysiology, and surface ECG P wave morphology remains primitive. The magnetic electroanatomical mapping and display system (CARTO) offers an on-line display of electrical activation and/or signal amplitude related to the anatomical location of the recorded sites in the mapped chamber. A window of electrical interest is established based on signals timed from an electrical reference that usually represents a fixed electrogram recording from the coronary sinus or the atrial appendage. This window of electrical interest is established to include atrial activation prior to the onset of the P wave activity associated with the site of origin of a focal atrial tachycardia. Anatomical and electrical landmarks are defined with limited fluoroscopic imaging support and more detailed global chamber and more focal atrial mapping can be performed with minimal fluoroscopic guidance. A three-dimensional color map representing atrial activation or voltage amplitude at the magnetically defined anatomical sites is displayed with on-line data acquisition. This display can be manipulated to facilitate viewing from any angle. Altering the zoom control, triangle fill threshold, clipping plane, or color range can all enhance the display of a more focal area of interest. We documented the feasibility of using this single mapping catheter technique for localizing and ablating focal atrial tachycardias. In a consecutive series of 8 patients with 9 focal atrial tachycardias, the use of the single catheter CARTO mapping system was associated with ablation success in all but one patient who had a left atrial tachycardia localized to the medial aspect of the orifice of the left atrial appendage. Only low power energy delivery was used in this patient because of the unavailability of temperature monitoring in the early version of the Navistar catheter, the location of the arrhythmia, and the history of arrhythmia control with flecainide. No attempt was made to limit fluoroscopy time in our study population. Nevertheless, despite data acquisition from 120-320 anatomically distinct sites during global and more detailed focal atrial mapping, total fluoroscopy exposure was typically < 30 minutes and was as little as 12 minutes. The detailed display capabilities of the CARTO system appear to offer the potential of enhancing our understanding of atrial anatomy, atrial activation, and their relationship to surface ECG P wave morphology during focal atrial tachycardias.
使用标准导管标测和消融技术很难实现局灶性房性心动过速消融的一致成功。此外，我们对心房解剖结构、电生理学和体表心电图P波形态之间复杂关系的理解仍然很原始。磁电解剖标测和显示系统（CARTO）可在线显示与标测心腔内记录部位解剖位置相关的电激动和/或信号幅度。基于从电参考点计时的信号建立一个电感兴趣窗口，该电参考点通常代表来自冠状窦或心房附件的固定电图记录。建立这个电感兴趣窗口是为了包括与局灶性房性心动过速起源部位相关的P波活动开始之前的心房激动。在有限的透视成像支持下定义解剖和电标志，并且可以在最少透视引导下进行更详细的全心腔和更局灶性的心房标测。在在线数据采集时，显示一个代表磁定义解剖部位心房激动或电压幅度的三维彩色图。这个显示可以进行操作以便从任何角度便于观察。改变缩放控制、三角形填充阈值、剪辑平面或颜色范围都可以增强对更局灶性感兴趣区域的显示。我们记录了使用这种单导管技术定位和消融局灶性房性心动过速的可行性。在连续的8例患者中的9次局灶性房性心动过速中，使用单导管CARTO标测系统除1例左房性心动过速定位于左心耳口内侧的患者外，所有患者消融均成功。由于早期版本的Navistar导管无法进行温度监测、心律失常的位置以及氟卡尼控制心律失常的病史，该患者仅使用了低能量输送。在我们的研究人群中没有试图限制透视时间。然而，尽管在全心腔和更详细的局灶性心房标测期间从120 - 320个解剖学上不同的部位采集了数据，但总的透视暴露时间通常<30分钟，最短为12分钟。CARTO系统的详细显示能力似乎有潜力增强我们对局灶性房性心动过速期间心房解剖结构、心房激动及其与体表心电图P波形态关系的理解。
