Linlin Wang, Xiangwei Ding, Weizhu Ju, Hongwu Chen, Kai Gu, Mingfang Li, Minglong Chen, Gang Yang
{"title":"典型心房扑动首选波阵面消融反应的启示","authors":"Linlin Wang, Xiangwei Ding, Weizhu Ju, Hongwu Chen, Kai Gu, Mingfang Li, Minglong Chen, Gang Yang","doi":"10.1007/s10840-024-01911-x","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>The heterogeneous conduction properties through the cavotricuspid isthmus (CTI) in typical atrial flutter (AFL) have not yet been well elucidated.</p><h3 data-test=\"abstract-sub-heading\">Objective</h3><p>We sought to investigate preferential conduction through the CTI and the efficacy of ablation targeting preferential wavefront (PW) guided by ultra-high-resolution mapping.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In retrospective study, 28 patients were enrolled. Wavefront propagation patterns through the CTI and ablation responses at the location of PW were evaluated. In the following prospective study, 23 patients with predominant PW across the CTI were enrolled and assigned to the arm of PW prior ablation and the arm of conventional ablation.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Five activation patterns were noticed in the retrospective study. The termination sites were exactly located at the PW in 18 of 28 patients (64.3%). The width of the PW in direct termination group was significantly narrower than that in the CL prolongation before termination group (16.6 ± 1.0 mm vs. 23.3 ± 3.4 mm, respectively, <i>p</i> = 0.025). In the prospective study, the voltage of PW region was significantly higher than non-PW regions both from unipolar and bipolar mapping. 21 of 23 patients (91.3%) were terminated at PW. AFL could no longer be induced immediately after termination. The time from radiofrequency application to AFL termination and to achieve bidirectional conduction block was significantly shorter in PW prior ablation arm than that in conventional ablation group (<i>p</i> < 0.05).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Ablation targeting the PW first could be more efficient to terminate typical AFL and to achieve the endpoint of bidirectional conduction block.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":"403 1","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Lessons from ablation responses to preferential wavefront in typical atrial flutter\",\"authors\":\"Linlin Wang, Xiangwei Ding, Weizhu Ju, Hongwu Chen, Kai Gu, Mingfang Li, Minglong Chen, Gang Yang\",\"doi\":\"10.1007/s10840-024-01911-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Background</h3><p>The heterogeneous conduction properties through the cavotricuspid isthmus (CTI) in typical atrial flutter (AFL) have not yet been well elucidated.</p><h3 data-test=\\\"abstract-sub-heading\\\">Objective</h3><p>We sought to investigate preferential conduction through the CTI and the efficacy of ablation targeting preferential wavefront (PW) guided by ultra-high-resolution mapping.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>In retrospective study, 28 patients were enrolled. Wavefront propagation patterns through the CTI and ablation responses at the location of PW were evaluated. In the following prospective study, 23 patients with predominant PW across the CTI were enrolled and assigned to the arm of PW prior ablation and the arm of conventional ablation.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>Five activation patterns were noticed in the retrospective study. The termination sites were exactly located at the PW in 18 of 28 patients (64.3%). The width of the PW in direct termination group was significantly narrower than that in the CL prolongation before termination group (16.6 ± 1.0 mm vs. 23.3 ± 3.4 mm, respectively, <i>p</i> = 0.025). In the prospective study, the voltage of PW region was significantly higher than non-PW regions both from unipolar and bipolar mapping. 21 of 23 patients (91.3%) were terminated at PW. AFL could no longer be induced immediately after termination. 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Lessons from ablation responses to preferential wavefront in typical atrial flutter
Background
The heterogeneous conduction properties through the cavotricuspid isthmus (CTI) in typical atrial flutter (AFL) have not yet been well elucidated.
Objective
We sought to investigate preferential conduction through the CTI and the efficacy of ablation targeting preferential wavefront (PW) guided by ultra-high-resolution mapping.
Methods
In retrospective study, 28 patients were enrolled. Wavefront propagation patterns through the CTI and ablation responses at the location of PW were evaluated. In the following prospective study, 23 patients with predominant PW across the CTI were enrolled and assigned to the arm of PW prior ablation and the arm of conventional ablation.
Results
Five activation patterns were noticed in the retrospective study. The termination sites were exactly located at the PW in 18 of 28 patients (64.3%). The width of the PW in direct termination group was significantly narrower than that in the CL prolongation before termination group (16.6 ± 1.0 mm vs. 23.3 ± 3.4 mm, respectively, p = 0.025). In the prospective study, the voltage of PW region was significantly higher than non-PW regions both from unipolar and bipolar mapping. 21 of 23 patients (91.3%) were terminated at PW. AFL could no longer be induced immediately after termination. The time from radiofrequency application to AFL termination and to achieve bidirectional conduction block was significantly shorter in PW prior ablation arm than that in conventional ablation group (p < 0.05).
Conclusions
Ablation targeting the PW first could be more efficient to terminate typical AFL and to achieve the endpoint of bidirectional conduction block.
期刊介绍:
The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.