高密度标测技术结合相干分析在复杂房性心动过速导管消融中的应用

Application of high density mapping combined with coherence in catheter ablation of complex atrial tachycardia

目的评估高密度标测技术结合相干分析在复杂房性心动过速(房速)机制研究中的作用。方法本研究为前后对照研究。应用高密度标测技术结合相干分析(Carto 3版本7, 简称V7系统)回顾分析2019年8月20日至2022年6月30日于广东省人民医院接受传统高密度标测技术(Carto 3版本6, 简称V6系统)指导下的房速病例。病例入选标准:心房解剖建模完整;房速标测每个心腔≥1 000个激活点, 填充阈值≤15 mm, 单个心腔内标测区域完整。分别由2名电生理专业人士独立通过V7系统回顾激动图, 记录高密度标测技术结合相干分析解读与传统高密度标测的房速机制是否一致, 并对差异病例进行分析。结果连续纳入传统高密度标测指导下导管消融的房速患者101例, 共131份房速激动标测图, 符合入选标准的118份。V7系统回顾性分析发现, 112份(94.9%, 112/118)对于房速机制的解读与V6系统一致, 6份(5.1%, 6/118)不一致。无心脏手术史的房速机制两者解读的一致性高(100.0%, 19/19)。心脏外科术后和/或导管消融术后瘢痕相关房速激动标测图共99份, 93份(93.9%, 93/99)解读一致, 6份(6.1%, 6/99)不一致, 其中3份为V6系统指导下经历多次标测与消融, 2份为既往术者对折返环误读致消融失败, 1份为V6系统提示为阻滞区, V7系统提示可能有缓慢传导, V7系统可解释既往导管消融失败或过程曲折的可能原因。这6份不一致的房速中, 4份为心脏外科术后, 1份为心房颤动导管消融术后, 1份为心脏外科术及心房颤动导管消融术后。结论高密度标测技术结合相干分析可能更直观地判断折返环及激动传导方向, 尤其针对瘢痕相关的房速。

Objective To evaluate the role of high density mapping(HDM)combined with coherence in the study of complex atrial tachycardia(AT).Methods This study was a pre and post control study.HDM combined with coherent analysis(Carto 3 version 7,referred to as V7 system)was used to retrospectively analyze the AT cases under the guidance of traditional HDM(Carto 3 Version 6,referred to as V6 system)in Guangdong Provincial People’s Hospital from August 20,2019 to June 30,2022.Cases selection criteria included complete atrial anatomical modeling,AT mapping involves≥1000 activation points per cardiac cavity,with a filling threshold of≤15 mm,and a complete mapping area within a single cardiac cavity.Two electrophysiological professionals independently reviewed the excitation map through V7 system,and recorded whether the interpretation of V7 system was consistent with the mechanism of AT in traditional V6 system.The differential cases were analyzed.Results A total of 101 AT patients who underwent catheter ablation under the guidance of traditional HDM were included consecutively.There were 131 AT maps,and 118 AT maps met the inclusion criteria.All 112(94.9%,112/118)AT maps had consistent interpretations of the AT mechanism with the V6 system reviewed by V7 system,while 6(5.1%,6/118)AT maps had inconsistent interpretations.There was a high consistency(100.0%,19/19)in the interpretation of the mechanism of AT without a history of cardiac surgery or ablation between the two mapping systems.Among patients after cardiac surgery and/or catheter ablation,there were 99 scar related AT.Ninety-three maps(93.9%,93/99)were consistent,and 6(6.1%,6/99)were inconsistent,of which 3 were after multiple mapping and ablation under the guidance of the V6 system,2 were failed ablations due to misreading of the reentries by previous operators,and the last one showed a blocked area indicated by V6 system while V7 system suggested slow conduction.V7 system could explain the possible reasons for previous catheter ablation failures or process twists.Among these 6 inconsistent AT cases,4 were after cardiac surgery,1 was after atrial fibrillation catheter ablation,and 1 was after cardiac surgery and atrial fibrillation catheter ablation.Conclusion HDM combined with coherence might be more intuitive in determining the direction of reentries and excitatory conduction,especially for scar related AT.