Extrastimuli-assisted Functional Mapping Improves Ventricular Tachycardia Ablation Outcomes: A Systematic Review, Meta-analysis, and Meta-regression.

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2025-04-04 DOI:10.1016/j.hrthm.2025.03.2000

Bruno Wilnes, Beatriz Castello-Branco, Eduardo Maia Martins Pereira, Luiza Marinho Lopes, Vivian Barroso Santos, Ana Clara Bicalho, Lucas Melo, Sara Regina Silva Cupertino, Anna Terra França, Marcos Roberto Queiroz França, Gustavo de Araújo Silva, Marina Pereira Mayrink, Isabella Moreira Gonzalez Fonseca, Reynaldo Castro de Miranda, José Luiz Padilha da Silva, Maria Carmo Pereira Nunes, Andre Assis Lopes do Carmo

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引用次数: 0

Abstract

Background: In the context of VT ablation, functional electroanatomic mapping techniques may help identify arrhythmogenic substrates in scarred and normal voltage areas. Additionally, extrastimuli-assisted (dynamic) mapping may be more effective than intrinsic rhythm (static) approaches to uncover key ablation targets, potentially improving procedure outcomes.

Objectives: To assess the efficacy and safety of functional mapping-assisted ventricular tachycardia (VT) ablation and compare procedural outcomes between dynamic and static mapping approaches.

Methods: PubMed/MEDLINE, Scopus, Web of Science, and Cochrane databases were searched using MeSH terms "Ventricular Tachycardia Ablation", "Functional Mapping", "Recurrence", "Complications", and similar keywords. Meta-analyses of single proportions, rates, and means were performed, employing random-effects models and p<0.05. Subgroup analysis and meta-regression were performed.

Results: We included 16 studies, covering 674 patients, with follow-up ranging from 6 to 38.1 ±29.7 months. Ischemic etiology comprised 490 (72.7%) patients, left ventricular ejection fraction (LVEF) varied from 25 ±10% to 41.5 ±13.8%. Dynamic mapping was used in 9 (57.1%) studies, 6 (37.5%) employed static techniques, and 1 (6.3%) used a mixed approach. Procedure duration (p=0.520) or complication incidence (p=0.110) were similar between dynamic and static mapping modalities. Dynamic mapping subgroup exhibited significantly lower VT recurrence rate when compared to the static mapping population (p<0.010). This result persisted on a meta-regression model adjusted for ischemic etiology and LVEF, demonstrating that dynamic functional mapping was independently associated with lower recurrence rates (p=0.005).

Conclusion: Functional mapping demonstrated to be safe for VT ablation. Dynamic functional mapping independently associated with reduced post-ablation recurrence rates without significantly increasing procedure duration.

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刺激外辅助功能定位改善室性心动过速消融结果：系统回顾、荟萃分析和荟萃回归。

背景：在室性心动过速消融的背景下，功能电解剖作图技术可能有助于识别疤痕区和正常电压区的致心律失常底物。此外，刺激外辅助（动态）测绘可能比内在节律（静态）方法更有效地发现关键消融目标，潜在地改善手术结果。目的：评估功能定位辅助室性心动过速（VT）消融的有效性和安全性，并比较动态和静态定位方法的手术结果。方法：检索PubMed/MEDLINE、Scopus、Web of Science和Cochrane数据库，检索词为“室性心动过速消融”、“功能映射”、“复发”、“并发症”及类似关键词。采用随机效应模型对单一比例、发生率和方法进行meta分析。结果：我们纳入了16项研究，涵盖674例患者，随访时间为6至38.1±29.7个月。缺血性病因490例（72.7%），左室射血分数（LVEF）从25±10%到41.5±13.8%不等。9项（57.1%）研究采用动态制图，6项（37.5%）采用静态技术，1项（6.3%）采用混合方法。动态和静态映射方式的手术时间（p=0.520）或并发症发生率（p=0.110）相似。动态测图组与静态测图组相比，房颤复发率明显降低(结论：功能测图对房颤消融是安全的。动态功能定位与消融后复发率的降低独立相关，而不显著增加手术时间。

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

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

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.