Raphaël P Martins, Konstantinos Vlachos, Nuno Cortez-Dias, Pierre Groussin, Redwane Rakza, Nathalie Behar, Philippe Mabo, Christophe Leclercq, Dominique Pavin, Karim Benali
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引用次数: 0
Abstract
Background: Ablation of infrequent premature ventricular complexes (PVC) is challenging.
Objectives: A novel mapping strategy for patients with infrequent PVCs, called multielectrode catheter-induced ectopy mapping (MECIE mapping) is described, aiming at performing a hybrid activation/template matching map by taking advantage of multielectrode catheter-induced arrhythmogenicity.
Methods: Patients referred to 3 tertiary centers for PVC ablation were prospectively enrolled if they had infrequent PVCs (less than 1 PVC per minute) at onset of procedure, preventing the realization of an accurate activation map. A detailed MECIE map was created using the arrhythmogenic property of multielectrode catheters, corresponding to a local activation time (LAT) map generated by annotating LAT from mechanical PVCs. Selecting mechanical PVCs with ≥99% concordance with the clinical PVC spotted the site of origin at which ablation was delivered. The primary endpoint was long-term success, defined as an >80% reduction in PVC burden during follow-up.
Results: A total of 29 patients were included, with 25 (interquartile range [IQR] 7-30) PVCs in the initial 30 minutes of procedure. During MECIE mapping, 67 (IQR 1-332) points with ≥99% concordance were acquired. The best LAT was 34.0 ± 9.5 ms before QRS onset. Pace mapping was 97.4 ± 3.1% compared with the clinical PVC. Ablation was locally performed. After 13.2 ± 5.1 months of follow-up, 27 patients (93.1 %) had 80% reduction in PVC burden, and only 2 patients had symptomatic recurrences.
Conclusion: A detailed MECIE map taking advantage of multielectrode catheter arrhythmogenicity may be generated to spot the origin of PVCs, a strategy resulting in a good procedural success rate.
期刊介绍:
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.