Identifying extra pulmonary vein targets for persistent atrial fibrillation ablation: bridging advanced and conventional mapping techniques.

IF 7.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Europace Pub Date : 2025-03-28 DOI:10.1093/europace/euaf048
Alexander J Sharp, Michael T Pope, Andre Briosa E Gala, Richard Varini, Abhirup Banerjee, Timothy R Betts
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引用次数: 0

Abstract

Aims: Advanced technologies such as charge density mapping (CDM) show promise in guiding adjuvant ablation in patients with persistent atrial fibrillation (AF); however, their limited availability restricts widespread adoption. We sought to determine whether regions of the left atrium containing CDM-identified pivoting and rotational propagation patterns during AF could also be reliably identified using more conventional contact mapping techniques.

Methods and results: Twenty-two patients undergoing de novo ablation of persistent AF underwent both CDM and electroanatomic voltage mapping during AF and sinus rhythm with multiple pacing protocols. Through the use of a left atrium statistical shape model, the location of distinctive propagation patterns identified by CDM was compared with low-voltage areas (LVAs) and regions of slow conduction velocity (CV). Neither LVA nor CV mapping during paced rhythms reliably identified regions containing CDM propagation patterns. Conduction velocity mapping during AF did correlate with these regions (ρ = -0.63, P < 0.0001 for pivoting patterns; ρ = -0.54, P < 0.0001 for rotational patterns). These propagation patterns consistently occurred in two specific anatomical regions across patients: the anteroseptal and inferoposterior walls of the left atrium.

Conclusion: Mapping techniques during paced rhythms do not reliably correspond with regions of CDM-identified propagation patterns in persistent AF. However, these propagation patterns are consistently observed in two specific anatomical regions, suggesting a predisposition to abnormal electrophysiological properties. While further research is needed, these regions may serve as promising targets for empirical ablation, potentially reducing the reliance on complex mapping techniques.

确定持续性房颤消融的肺静脉外靶点:连接先进和传统的定位技术。
背景和目的:电荷密度测绘(CDM)等先进技术有望指导持续性心房颤动(AF)患者的辅助消融;然而,它们有限的可用性限制了它们的广泛采用。我们试图确定含有cdm识别的AF期间的旋转和旋转传播模式的左心房区域是否也可以使用更传统的接触映射技术可靠地识别。方法:22例持续性房颤从头消融患者在房颤和窦性心律期间采用多重起搏方案进行CDM和电解剖电压测绘。利用左心房统计形态模型,将CDM识别的独特传播模式的位置与低压区(LVAs)和慢传导速度区(CV)进行比较。结果:在节奏节奏中,LVA和CV映射都不能可靠地识别出包含CDM传播模式的区域。心房颤动期间的CV映射与这些区域相关(ρ = -0.63, p < 0.0001);ρ = -0.54,旋转模式p < 0.0001)。这些传播模式一致地发生在患者的两个特定解剖区域:左心房的前间隔和后壁。结论:节奏节律期间的定位技术并不可靠地与cdm识别的持续性房颤传播模式区域相对应。然而,这些传播模式在两个特定的解剖区域一致地被观察到,这表明存在异常电生理特性的易感性。虽然需要进一步的研究,但这些区域可能成为经验消融的有希望的目标,可能减少对复杂测绘技术的依赖。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Europace
Europace 医学-心血管系统
CiteScore
10.30
自引率
8.20%
发文量
851
审稿时长
3-6 weeks
期刊介绍: EP - Europace - European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology of the European Heart Rhythm Association of the European Society of Cardiology. The journal aims to provide an avenue of communication of top quality European and international original scientific work and reviews in the fields of Arrhythmias, Pacing and Cellular Electrophysiology. The Journal offers the reader a collection of contemporary original peer-reviewed papers, invited papers and editorial comments together with book reviews and correspondence.
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