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IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation Pub Date : 2025-03-01 DOI:10.1016/j.hlc.2024.10.018

Robert D. Anderson MBBS, PhD , Stephane Masse MASc , Joshua Hawson MBBS , Geoffrey Lee MBCHB, PhD , Mukund Prabhu MD, DM , Abhishek Bhaskaran MBBS, MD, PhD , Andrew C.T. Ha MD, MSc , Krishnakumar Nair MD , Vijay Chauhan MD , Kumaraswamy Nanthakumar MD

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引用次数: 0

摘要

背景：流出道（OT）室早复合征（PVC）部位的定位以单极和双极局部激活时间（LAT）为指导。然而，如果病灶位于室内或远处，基于 LAT 的定位可能不准确。目的：我们评估了超生理 CV（即表面等时表观弥散（IAD）映射）是否可用于准确区分右室和左室 OT PVC 起源，从而指导 OT PVC 消融的成功部位：方法：如果右心室 OT 图谱显示双极电图（EGM）最早到达 QRS、双极电图最早到达第一个偏转单极 EGM（unipolarearliest）、双极电图最早到达单极 -dV/dTmax、单极 -dV/dTmax 到达 QRS、早期 LAT 突波的数量和最早等时突波的表面积，则进行左心室 OT 图谱。使用 MATLAB 中的自定义算法计算多项式 CV，截距在 1 到 100,000 厘米/秒之间，用于创建 IAD，称为表观弥散指数。评估了 IAD 区分成功和不成功 OT 站点的准确性，并与传统的 EGM 指数进行了比较：双极最早至 QRS（28.5±7.3 ms vs 17.8±5.7 ms）；pmax 至 QRS（0.4±26.4 ms vs -6.4±13.4 ms；p=0.25）可区分成功和不成功的 OT PVC 位点。早期等时突破面积小于 1 cm2 和突破少于两次表明一侧成功（梨状区至单极-dV/dTmax 和至单极最远均不具预测性（分别为 28.1±27.7 vs 24.2±13.3 ms；p=0.97 和 6.4±7.3 vs 6.4±5.8 ms；p=0.8）。使用表观弥散指数临界值 20,000 cm/s，IAD 似乎可以区分成功和不成功的部位，准确率为 93.8%，接收器操作者特征下面积为 0.95：IAD 是对三维激活图谱表面的一种逼真的二维解释，可与 OT 起源相关联，从而指导导管消融的成功侧。

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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Isochronal Apparent Dispersion at Early Activation Sites Accurately Identifies Outflow Tract Ventricular Ectopy Sites

Background

Localisation of outflow tract (OT) premature ventricular complex (PVC) sites is guided by unipolar and bipolar local activation time (LAT). However, LAT-based localisation can be inaccurate if the site is intramural or distant. Deep foci produce rapid conduction velocity (CV) if the wavefront is tangential to the surface.

Aim

We evaluated whether supraphysiological CV, referred to as surface isochronal apparent dispersion (IAD) mapping, can be used to accurately differentiate right and left ventricular OT PVC origin, guiding the successful site for OT PVC ablation.

Method

Left ventricular OT mapping was performed if right ventricular OT mapping demonstrated a bipolar electrogram (EGM) <20 ms. The earliest EGMs underwent analysis of the following: first deflection bipolar EGM (bipolar_earliest) to QRS, bipolar_earliest to first deflection unipolar EGM (unipolar_earliest), bipolar_earliest to unipolar −dV/dT_max, unipolar −dV/dT_max to QRS, number of early LAT breakouts, and the surface area of the earliest isochronal breakout. Polynomial CV was calculated using a custom algorithm in MATLAB using cut-offs between 1 and 100,000 cm/s and used to create IAD, referred to as apparent dispersion index. The accuracy of IAD to distinguish between successful and unsuccessful OT sites was assessed and compared with conventional EGM indices.

Results

Bipolar_earliest to QRS (28.5±7.3 ms vs 17.8±5.7 ms; p<0.05) is superior to unipolar −dV/dt_max to QRS (0.4±26.4 ms vs −6.4±13.4 ms; p=0.25) in differentiating successful and unsuccessful OT PVC sites. An early isochronal breakout area of less than 1 cm² and less than two breakouts indicates a successful side (both p<0.05). Bipolar_earliest to unipolar −dV/dT_max and to unipolar_earliest were not predictive (28.1±27.7 vs 24.2±13.3 ms; p=0.97 and 6.4±7.3 vs 6.4±5.8 ms; p=0.8, respectively). IAD appears to differentiate between successful and unsuccessful sites using an apparent dispersion index cut-off of 20,000 cm/s, with an accuracy of 93.8% and area under the receiver operator characteristic of 0.95.

Conclusions

IAD is a realistic two-dimensional interpretation of the three-dimensional activation mapping surface that may be associated with OT origins to guide a successful side of catheter ablation.

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来源期刊

Heart, Lung and Circulation CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.50

自引率

3.80%

发文量

912

审稿时长

11.9 weeks

期刊介绍： Heart, Lung and Circulation publishes articles integrating clinical and research activities in the fields of basic cardiovascular science, clinical cardiology and cardiac surgery, with a focus on emerging issues in cardiovascular disease. The journal promotes multidisciplinary dialogue between cardiologists, cardiothoracic surgeons, cardio-pulmonary physicians and cardiovascular scientists.