多向起搏对激活和复极化参数的影响以定位缺血性室性心动过速回路

IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Adam S C Dennis, Michele Orini, Eva Melis Hesselkilde, Arnela Saljic, Benedikt M Linz, Stefan M Sattler, James Williams, Jacob Tfelt-Hansen, Thomas Jespersen, Anthony W C Chow, Pier D Lambiase
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引用次数: 0

摘要

背景:在室性心动过速(VT)中,确定心律失常发生部位的最佳底物映射策略尚未确立:本研究旨在评估多向起搏对特定传导和复极化指标分布的影响,以便在猪心梗模型中定位再入性室速部位:使用Advisor HD Grid(雅培)在右心室(RV)、左心室、双心室起搏(BIV)和窦性心律(SR)时绘制13头慢性心肌梗死猪的基底图。划定了舒张早期、中期和晚期信号的VT关键部位。再入的易损部位被定义为 QRS 波群内和 QRS 波群后激活时间最晚、激活和激活-恢复间期梯度最大的部位。测量了 20 个最易发生 VT 的部位与舒张期 VT 点之间的距离,并使用接收器工作特征曲线下的面积评估了 VT 点的识别:结果:共绘制了 34 个 VT,48 个窦房和起搏图(10 个 BIV、13 个左心室、13 个 RV、12 个 SR)。SR 的晚期电位图被作为既定的临床标准进行比较。BIV 起搏的最新激活时间为 VT 峡部提供了最接近的定位(中位数:5.5 毫米;IQR:7.15 毫米;P < 0.005)。使用 RV 起搏的激活-恢复间期梯度最接近 VT 出口和入口的定位(中位数:10.6 毫米;IQR:5.0 毫米;P < 0.005 和 9.4 毫米;IQR:8.0 毫米;P < 0.05)。全局灵敏度和特异性分析表明,SR 中的激活梯度-恢复间隔的接收者操作特征曲线下的面积最大,激活梯度定时的结果与之相似:多向起搏结合传导和复极化参数能更好地定位 VT 舒张临界点和 SR 迟电位。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of Multidirectional Pacing on Activation and Repolarization Parameters to Localize Ischemic Ventricular Tachycardia Circuits.

Background: In ventricular tachycardia (VT), optimal substrate mapping strategies identifying arrhythmogenic sites are not established.

Objectives: This study sought to evaluate multidirectional pacing on the distribution of specific conduction and repolarization metrics to localize re-entrant VT sites in a porcine infarct model.

Methods: Substrate maps were created in 13 pigs with chronic myocardial infarction using the Advisor HD Grid (Abbott) during right ventricular (RV), left ventricular, biventricular pacing (BIV), and sinus rhythm (SR). Critical VT sites of early-, mid-, and late-diastolic signals were delineated. Vulnerable sites to re-entry were defined as sites of latest activation timing within and post-QRS complex, largest activation and activation-recovery interval gradients. Distances between the 20 most vulnerable sites and diastolic VT points were measured, and identification of VT points was assessed using the area under the receiver-operating characteristic curve.

Results: A total of 34 VTs were mapped, and 48 sinus and pacing maps were obtained (10 BIV, 13 left ventricular, 13 RV, 12 SR). Late potential mapping in SR was taken as the established clinical standard for comparison. Latest activation time with BIV pacing provided the closest localization for VT isthmus (median 5.5 mm; IQR: 7.15 mm; P < 0.005). The gradient of activation-recovery interval using RV pacing had closest localization for VT exit and entrance (median 10.6 mm; IQR: 5.0 mm; P < 0.005 and 9.4 mm; IQR: 8.0 mm; P < 0.05). Global sensitivity and specificity analysis showed that gradient of activation-recovery interval in SR achieved the highest area under the receiver-operating characteristic curve, with similar results from the gradient of activation timing.

Conclusions: Multidirectional pacing in combination with conduction and repolarization parameters enables better localization of VT diastolic critical sites vs SR late potentials.

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来源期刊
JACC. Clinical electrophysiology
JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
5.70%
发文量
250
期刊介绍: JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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