Differential Pacing Maneuver From the Vein of Marshall.

IF 9.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation. Arrhythmia and electrophysiology Pub Date : 2024-04-01 Epub Date: 2024-02-23 DOI:10.1161/CIRCEP.123.012420

Naohiko Kawaguchi, Yasuaki Tanaka, Kenji Okubo, Shinichi Tachibana, Emiko Nakashima, Katsumasa Takagi, Hiroyuki Hikita, Tetsuo Sasano, Atsushi Takahashi

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Abstract

Background: Bidirectional mitral isthmus (MI) block is conventionally verified by differential pacing from the coronary sinus (CS) and its sequence change. This study aimed to evaluate the ability of differential pacing from the vein of Marshall (VOM) to detect epicardial MI connections.

Methods: Radiofrequency and VOM ethanol MI ablation were performed with a VOM electrode catheter inserted to the septal side of the ablation line. MI block was verified using conventional CS pacing. To perform differential VOM pacing analysis, initial pacing was delivered from a distal VOM bipole closer to the block line, and then from a proximal VOM bipole. The intervals from pacing stimulus during different VOM pacing sites to the electrogram recorded through the CS catheter on the opposite side of the line were compared. When the interval during distal VOM pacing was longer than that during proximal VOM pacing, it indicated a VOM connection block; however, if the former interval was shorter, the connection through the VOM was considered persistent.

Results: Overall, 50 patients were evaluated. According to CS pacing, MI ablation was incomplete in 9 patients, in whom the analysis indicated persistent VOM connection. Among 41 patients with complete MI block, confirmed by CS finding, in 30 (73%) patients, the interval during distal VOM pacing was longer than that during proximal VOM pacing by 11±5 ms. However, in 11 patients (27%) the former interval was revealed to be shorter than the latter by 16±8 ms, indicating residual VOM connection. Conduction time across the line was significantly shorter in 11 patients than in the other 30 (166±21 versus 197±36 ms; P<0.01). Ten successful reevaluated analyses after VOM ethanol and further radiofrequency ablation of the connection indicated VOM block achievement.

Conclusions: Differential VOM pacing maneuver reflects the VOM conduction status. This maneuver can uncover residual epicardial connections that are missing with CS pacing.

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来自马歇尔静脉的差分起搏手法。

背景：双向二尖瓣峡部（MI）阻滞传统上是通过冠状窦（CS）的不同起搏及其序列变化来验证的。本研究旨在评估从马歇尔静脉（VOM）进行差分起搏检测心外膜 MI 连接的能力：方法：将 VOM 电极导管插入消融线的室间隔侧，进行射频和 VOM 乙醇 MI 消融。使用常规 CS 起搏验证 MI 阻滞。为了进行差异 VOM 起搏分析，首先从靠近阻滞线的远端 VOM 双极进行起搏，然后再从近端 VOM 双极进行起搏。比较从不同 VOM 起搏部位的起搏刺激到通过阻滞线另一侧的 CS 导管记录到的电图的时间间隔。如果远端 VOM 起搏时的间隔长于近端 VOM 起搏时的间隔，则表明 VOM 连接阻滞；但如果前者的间隔较短，则认为通过 VOM 的连接持续存在：共对 50 名患者进行了评估。根据 CS，9 名患者的起搏 MI 消融不完全，分析表明这些患者的 VOM 连接持续存在。在 41 例经 CS 结果证实的完全 MI 阻滞患者中，有 30 例（73%）患者的远端 VOM 起搏间期比近端 VOM 起搏间期长 11±5 毫秒。然而，在 11 名患者（27%）中，前者的间期比后者短 16±8 毫秒，这表明 VOM 连接残留。11 名患者的跨线传导时间明显短于其他 30 名患者（166±21 对 197±36 毫秒；PC 结论：差异 VOM 起搏操作反映了 VOM 的传导状态。该操作可发现 CS 起搏时缺失的残余心外膜连接。

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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来源期刊

Circulation. Arrhythmia and electrophysiology 医学-心血管系统

CiteScore

13.70

自引率

4.80%

发文量

187

审稿时长

4-8 weeks

期刊介绍： Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.