Ventricular substrate characteristics using omnipolar technology-derived vector disarray and peak frequency
Notice bibliographique
Résumé
Abstract Background Three-dimensional electroanatomic mapping and ablation of ventricular tachycardias (VT) is a complex process that integrates data from multiple procedural steps, including substrate and activation mapping. Purpose To streamline diagnostic and therapeutic interventions, we applied the omnipolar near-field technology algorithm, with the goal of integrating it into the study of low-voltage areas, deceleration zones (DZs), areas of vector disarray (in sinus rhythm, SR), and critical VT isthmus sites. Methods In this single-center retrospective study, three-dimensional electroanatomic maps in SR of 35 patients (August 2023 to August 2024) were analysed. Substrate analysis focused on identifying low-voltage areas, late potentials, local abnormal ventricular activities (LAVAs), and DZs. Procedures were performed using the EnSite X Cardiac Mapping System (Abbott) with the Advisor HD Grid Mapping Catheter (Abbott). Radiofrequency lesions were delivered when clinically indicated. To quantify vector disarray, we analysed low voltage areas (range 0.04-1.50 mV) displaying omnipolar vectors, and the percentage of disarrayed vectors was calculated manually. Maps were compared via emphasis maps, integrating information from VT and SR maps. Results Over a 12-month period, 10 patients (5 female) underwent transcatheter ventricular mapping procedures for diagnostic purposes, and 25 patients (2 female) underwent VT ablation. Median age was 70 (IQR 54-74) years, with 19 (55.29%) patients with a history of ischemic heart disease. The primary procedure indications were electrical storm in 12 (34.29%), and sustained VT in 13 (37.14%) patients. The approach was endocardial in 30 patients, epicardial in 2, and combined endo-epicardial in 3 patients. The median highest peak frequency (PF) in the SR substrate maps within low-voltage areas was 280 (250-315) Hz. Median vector disarray was 60.27% (51.7-67.9), without significant differences between ischaemic and non-ischaemic cardiomyopathies (p=0.070). Low-voltage areas of VT interest displayed higher peak frequencies and greater vector disarray. Regions with PF above 250 Hz would overlap with chaotic vector areas and low-voltage areas in the majority of patients (82.4% and 85.3% respectively). Among patients with and without area overlap, there were no statistically significant differences in disease type, vector disarray percentage, age, and LVEF, while patients with overlapping areas had significantly larger high-frequency regions (p=0.005 and p=0.006, respectively). Conclusion During sinus rhythm, localisation of areas with increased PF and chaotic and low-voltage areas is frequent, and may aid in the identification of colliding wavefronts in low-voltage tissues during SR, thus characterising a possible arrhythmic substrate. Future studies are needed to investigate its potential advantages to limit the requirement for VT activation mapping.Characteristics of the study population OTNF and vector disarray in SR and VT
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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 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| 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 ».