1155Assessment of transmurality during lesion formation with electrograms
Notice bibliographique
Résumé
Background: Real time lesion formation by means of the EGM analysis is needed after recent descriptions of the limitations of contact force catheters. A bipolar EGM amplitude (B-EGM) reduction of >75%, appearance of a QS pattern and disappearance of S-wave on the Unipolar-EGM (U-EGM) have been associated with transmurality of the lesion. These criteria are dependent on catheter orientation and the ability of the S waves to define local depolarization. A real-time assessment of lesion formation by means of EGMs is studied as a method for assessment of transmurality. Objectives: Describe real-time changes in EGMs to assess transmurality of the lesion. Methods: Eight Langendorff perfused rabbit (12) and pig (9) hearts were treated with 27 RF lesions at different powers and locations in the atrium and ventricle with assessment of lesion formation by EGM and confirmed with post-hoc histology. Recording of a EGM (perpendicular to the surface with interelectrode spacing of 2mm) in contact with the ablated tissue was performed. Assessment of Unipolar-EGM (filtered at 0.5 – 240 Hz) and Bipolar-EGM (filtered at 30Hz - 240Hz) was done qualitatively for pattern-identification (presence or absence of S wave in the unipolar recordings and QS pattern or non-QS pattern on filtered bipolar recordings) and automatically for peak-to-peak voltage amplitude measurement. Results: Transmurality was achieved in 15 of 27 lesions (55.6%). After 1W lesions delivered for 10 seconds (non-transmural) there was disappearance of the S wave in the U-EGM in 47% of the cases (7 of 15 lesions). Amongst all lesions at all powers, S wave in the U-EGM disappeared in 83% of non-transmural lesions indicating a poor specificity for assessment of transmurality. With regards to the B-EGM peak to peak voltage amplitude, after 1W lesions for 10 seconds (non-transmural) there was no change in the average voltage amplitude (-1%±57%, p=0.6) and B-EGM pattern was non-QS for all lesions. Amongst all lesions, peak to peak voltage amplitude was reduced by 80±21% in transmural lesions vs 60±17% in non-transmural lesions (p<0.05). A value of 78% reduction in peak to peak B-EGM voltage was linked to the highest AUC (0.86) when tracing a ROC-curve to assess for lesion transmurality (sensitivity of 73%, specificity of 83%). The filtered B-EGM was never a QS in transmural lesions. Conclusions: Assessment of lesion formation with traditional EGM criteria has poor predictive value for transmurality. A cutoff of >78% reduction in voltage peak to peak amplitude of a perpendicular B-EGM from baseline may be a useful tool to predict transmurality. In vivo, where catheter orientation is not reliable, an orientation-independent EGM recording may provide a better way to assess transmurality.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».