消融导管近远端激动间距定位左房-肺静脉电位传导缝隙的价值

The value of proximal to distal activation interval on ablation catheter for positioning left atrium-pulmonary vein potential conduction gaps

目的探讨阵发性心房颤动(简称房颤)环肺静脉前庭电隔离(CPVI)术中,标测消融导管近远端激动间距(ABLp-d AI)是否有助于定位初始环状消融线上的左房-肺静脉电位传导缝隙(gap)。方法 56例阵发性房颤患者,在EnSite NavX三维标测系统指导下行环同侧肺静脉前庭的线性消融和gap补充消融以达全部肺静脉电隔离。回顾分析窦性心律下两侧环线上178个补充消融点的局部心内电图,根据术中补充消融结果,将其分为有效组(gap)与无效组(非gap),比较两组间ABLp-d AI有无差异。结果有效组ABLp-d AI明显短于无效组[(28.75±19.74)ms vs(43.39±23.62)ms,P<0.05];ROC曲线分析显示,ABLp-d AI的曲线下面积是0.924,对于定位gap的最佳诊断阈值为25 ms,其对应的灵敏度、特异度、阳性预测价值和阴性预测价值分别为:88.2%、87.3%,、78.1%、92.9%。结论 CPVI术中,标测ABLp-d AI有助于准确定位初始环状消融线上的gap,提高阵发性房颤消融的效率。

Objective To investigate whether mapping of proximal to distal activation interval on ablation catheter （ABLp-d AI） during circumferential pulmonary vein isolation（CPVI） procedure could facilitate positioning left atrium-pul- monary vein potential conduction gaps on the first round ablation line for curing paroxysmal atrial fibrillation（AF）. Meth. ods Fifty six consecutive patients with paroxysmal AF underwent CPVI and gap ablation with the guidance of EnSite NavX system. Retrospective analysis of endocardium electrograms which were randomly recorded from 178 additional lesions during gap ablation on CPVI line in sinus rhythm. They were divided into effective group （true gap ） and noneffective group （false gap） according to the outcome then comparied the value of ABLp-d AI between this two groups. Results Compared with noneffective group , the value of ABLp-d AI in effective group was shorter [ （28.75±19.74） ms vs （43.39±23. 62） ms,P〈0.05 ]. The ROC curve analysis showed that the area under ROC curve of ABLp-d AI was 0.924 and the optimal diagnostic threshold for positioning gaps was 25 ms, the corresponding sensitivity, specificity, positive predictive value and negative predictive values were 88.2%, 87.3% ,78.1%, 92.9% respectively. Conclusion Mapping of ABLp-d AI can help positioning gaps on CPVI line and facilitate ablation of paroxysmal AF.