vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-2022-3-04vestar-1129Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESАлгоритм определения степени фиброза при картировании высокой плотностиAlgorithm for determining the fibrosis stage using high-density mappinghttps://orcid.org/0000-0002-4799-7456ДедухЕ. В.DedukhE. V.

Дедух Елизавета Викторовна

Москва, Большая Серпуховская ул., д. 27

Dedukh Elizaveta

Moscow, 27 Bolshaya Serpukhovskaya str.

dedukh.elizaveta@mail.ruhttps://orcid.org/0000-0003-3997-8252ЯшковМ. В.YashkovM. V.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya Serpukhovskaya str.

https://orcid.org/0000-0002-9280-9063ТаймасоваИ. А.TaymasovaI. A.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya Serpukhovskaya str.

https://orcid.org/0000-0001-7065-0250АртюхинаЕ. А.ArtyukhinaE. A.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya Serpukhovskaya str.

https://orcid.org/0000-0003-1791-9163РевишвилиА. Ш.RevishviliA. Sh.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya Serpukhovskaya str.

Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр хирургии имени А. В. Вишневского» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budget Institution “A. V Vishnevsky National Medical Research Center of Surgery” of the Ministry of Health of the Russian FederationRussian Federation2022200920222932936Copyright © Дедух Е.В., Яшков М.В., Таймасова И.А., Артюхина Е.А., Ревишвили А.Ш., 20222022Дедух Е.В., Яшков М.В., Таймасова И.А., Артюхина Е.А., Ревишвили А.Ш.Dedukh E.V., Yashkov M.V., Taymasova I.A., Artyukhina E.A., Revishvili A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1129Цель

Цель. Разработать алгоритм оценки степени фиброза по данным высокоплотного эндокардиального картирования и изучить влияние степени фиброза левого предсердия, выявленной с помощью высокоплотного электроанатомического картирования, на результаты катетерного лечения фибрилляции предсердий (ФП).

Методы исследования

Методы исследования. В исследование включено 64 пациента с пароксизмальной или персистирующей формами ФП, которым выполнялось высокоплотное картирование левого предсердия и катетерное лечение ФП. После интервенционной процедуры проводился анализ электроанатомических карт левого предсердия, оценивалась распространенность зон низкоамплитудной активности по разработанному алгоритму. Пациенты разделялись на 4 группы в зависимости от распространенности зон низкоамплитудной активности по аналогии со шкалой Utah.

Результаты

Результаты. В течение всего периода наблюдения (14,5±6,7 месяцев) рецидив ФП развился у 18 (28,1%) пациентов после процедуры аблации. У 6 (15,4%) пациентов из I, II групп и у 12 (48%) пациентов из III, IV групп зафиксирован рецидив ФП после катетерного лечения (p=0,02). Для выявления предикторов рецидива ФП в послеоперационном периоде был проведен логистический регрессионный анализ. В результате только распространенные зоны низкоамплитудной активности (>20%) являлись независимым предиктором рецидива ФП после изоляции устьев легочных вен, такая прогностическая модель была значимой (р=0,026). Значимые статистические различия между I, II и III, IV группой пациентов получены в показателях фракции выброса левого желудочка и длительности Р-зубца. У пациентов с распространенными зонами низкоамплитудной активности более низкая фракция выброса левого желудочка (62,8±6,9% против 58,1±5,7%, р=0,01), а длительность Р-зубца больше (84,7±8,2 мс против 101,5±11,0 мс, р=0,01).

Заключение

Заключение. Высокоплотное картирование левого предсердия перед интервенционным лечением ФП позволяет определить степень распространенности зон низкоамплитудной активности. При проведении регрессионного анализа доказано, что распространенные зоны низкоамплитудной активности являются независимым предиктором рецидива ФП после изоляции легочных вен. У пациентов с распространением зон низкоамплитудной активности более 20% - большая длительность Р-зубца и более низкая фракция выброса левого желудочка.

Aims

Aims. To develop an algorithm for assessing the stage of fibrosis based on high-density endocardial mapping. To study the effect of the stage of left atrial (LA) fibrosis on the results of atrial fibrillation (AF) catheter ablation.

Methods

Methods. The study included 64 patients with paroxysmal or persistent AF, who underwent high-density LA mapping and catheter ablation. After the intervention procedure, we analyzed the electroanatomical maps of the left atrium, assessed the prevalence of low-voltage areas according to the developed algorithm. Patients were divided into 4 groups depending on the prevalence of areas of low voltage based on the Utah score.

Results

Results. The follow-up period was 14.5 ± 6.7 months. AF recurrence developed in 18 (28.1%) patients after the ablation procedure. AF recurrence after ablation was more frequent in patients with a low-voltage area of more than 20% than in patients with a low-voltage left atrial area of less than 20%, 6 (15.4%) versus 12 (48%), p=0.02. A logistic regression analysis was performed to identify AF recurrence predictors in the postoperative period. As a result, only widespread areas of low-amplitude activity were an independent predictor of AF recurrence after the pulmonary veins isolation, this predictive model was significant (p=0.026). Significant statistical differences between groups I, II and III,I V are the ejection fractions and the duration of the P-wave. Patients with low-voltage regions have lower left ventricular ejection fraction (62.8±6.9% versus 58.1±5.7%, p=0.01), and longer P-wave duration (84.7±8,2 ms versus 101.5±11.0 ms, p=0.01).

Conclusion

Conclusion. LA high-density mapping before AF ablation makes it possible to determine the prevalence of low-voltage areas. After regression analysis, it was proved that common low-voltage areas are an independent predictor of AF recurrence after pulmonary vein isolation. Patients with low-voltage areas of more than 20% of the LA surface have longer P-wave duration and lower left ventricular ejection fraction.

высокоплотное картированиефибрилляция предсердийкатетерная аблацияфиброз левого предсердияhigh-density mappingatrial fibrillationcatheter ablationleft atrial fibrosisИсследование выполнено при финансовой поддержке РФФИ в рамках научного проекта № 20-315-90045.This work was supported by RFFR project № 20-315-90045.ReferencesCalkins H, Kuck KH, Cappato R, et al. 2012 HRS/ EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace. 2012;14(4): 528-606. https://doi.org/10.1093/europace/eus027.Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/ EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace. 2012;14(4): 528-606. https://doi.org/10.1093/europace/eus027.Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res. 2002;54(2): 230-246. https://doi.org/10.1016/s0008-6363(02)00258-4.Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res. 2002;54(2): 230-246. https://doi.org/10.1016/s0008-6363(02)00258-4.Frustaci A, Chimenti C, Bellocci F, et al. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation. 1997;96(4): 1180-1184. https://doi.org/10.1161/01.cir.96.4.1180.Frustaci A, Chimenti C, Bellocci F, et al. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation. 1997;96(4): 1180-1184. https://doi.org/10.1161/01.cir.96.4.1180.Marrouche NF, Wilber D, Hindricks G, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA. 2014;311(5): 498-506. https://doi.org/10.1001/jama.2014.3.Marrouche NF, Wilber D, Hindricks G, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA. 2014;311(5): 498-506. https://doi.org/10.1001/jama.2014.3.Spragg DD, Khurram I, Zimmerman SL, et al. Initial experience with magnetic resonance imaging of atrial scar and co-registration with electroanatomic voltage mapping during atrial fibrillation: success and limitations. Heart Rhythm. 2012;9(12): 2003-2009. https://doi.org/10.1016/j.hrthm.2012.08.039.Spragg DD, Khurram I, Zimmerman SL, et al. Initial experience with magnetic resonance imaging of atrial scar and co-registration with electroanatomic voltage mapping during atrial fibrillation: success and limitations. Heart Rhythm. 2012;9(12): 2003-2009. https://doi.org/10.1016/j.hrthm.2012.08.039.Malcolme-Lawes LC, Juli C, Karim R, et al. Automated analysis of atrial late gadolinium enhancement imaging that correlates with endocardial voltage and clinical outcomes: a 2-center study. Heart Rhythm. 2013;10(8):1184-1191. https://doi.org/10.1016/j.hrthm.2013.04.030Malcolme-Lawes LC, Juli C, Karim R, et al. Automated analysis of atrial late gadolinium enhancement imaging that correlates with endocardial voltage and clinical outcomes: a 2-center study. Heart Rhythm. 2013;10(8):1184-1191. https://doi.org/10.1016/j.hrthm.2013.04.030Verma A, Wazni OM, Marrouche NF, et al. Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation: an independent predictor of procedural failure. J Am Coll Cardiol. 2005;45(2): 285-292. https://doi.org/10.1016/j.jacc.2004.10.035Verma A, Wazni OM, Marrouche NF, et al. Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation: an independent predictor of procedural failure. J Am Coll Cardiol. 2005;45(2): 285-292. https://doi.org/10.1016/j.jacc.2004.10.035.Sanders P, Morton JB, Davidson NC, et al. Electrical remodeling of the atria in congestive heart failure: electrophysiological and electroanatomic mapping in humans. Circulation. 2003;108(12): 1461-1468. https://doi.org/10.1161/01.CIR.0000090688.49283.67.Sanders P, Morton JB, Davidson NC, et al. Electrical remodeling of the atria in congestive heart failure: electrophysiological and electroanatomic mapping in humans. Circulation. 2003;108(12): 1461-1468. https://doi.org/10.1161/01.CIR.0000090688.49283.67.Sanders P, Morton JB, Kistler PM, et al. Electrophysiological and electroanatomic characterization of the atria in sinus node disease: evidence of diffuse atrial remodeling. Circulation. 2004;109(12): 1514-1522. https://doi.org/10.1161/01.CIR.0000121734.47409.AA.Sanders P, Morton JB, Kistler PM, et al. Electrophysiological and electroanatomic characterization of the atria in sinus node disease: evidence of diffuse atrial remodeling. Circulation. 2004;109(12): 1514-1522. https://doi.org/10.1161/01.CIR.0000121734.47409.AA.Masuda M, Fujita M, Iida O, et al. Left atrial low-voltage areas predict atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation. Int J Cardiol. 2018;257:97-101. https://doi.org/10.1016/j.ijcard.2017.12.089.Masuda M, Fujita M, Iida O, et al. Left atrial low-voltage areas predict atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation. Int J Cardiol. 2018;257:97-101. https://doi.org/10.1016/j.ijcard.2017.12.089.Kapa S, Desjardins B, Callans DJ, et al. Contact electroanatomic mapping derived voltage criteria for characterizing left atrial scar in patients undergoing ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25(10): 1044-1052. https://doi.org/10.1111/jce.12452.Kapa S, Desjardins B, Callans DJ, et al. Contact electroanatomic mapping derived voltage criteria for characterizing left atrial scar in patients undergoing ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25(10): 1044-1052. https://doi.org/10.1111/jce.12452.Harrison JL, Jensen HK, Peel SA, et al. Cardiac magnetic resonance and electroanatomical mapping of acute and chronic atrial ablation injury: a histological validation study. Eur Heart J. 2014;35(22): 1486-1495. https://doi.org/10.1093/eurheartj/eht560.Harrison JL, Jensen HK, Peel SA, et al. Cardiac magnetic resonance and electroanatomical mapping of acute and chronic atrial ablation injury: a histological validation study. Eur Heart J. 2014;35(22): 1486-1495. https://doi.org/10.1093/eurheartj/eht560.Jadidi AS, Cochet H, Shah AJ, et al. Inverse relationship between fractionated electrograms and atrial fi-brosis in persistent atrial fibrillation: combined magnetic resonance imaging and high-density mapping. J Am Coll Cardiol. 2013;62(9): 802-812. https://doi.org/10.1016/j.jacc.2013.03.081.Jadidi AS, Cochet H, Shah AJ, et al. Inverse relationship between fractionated electrograms and atrial fi-brosis in persistent atrial fibrillation: combined magnetic resonance imaging and high-density mapping. J Am Coll Cardiol. 2013;62(9): 802-812. https://doi.org/10.1016/j.jacc.2013.03.081.Ballesteros G, Ravassa S, Bragard J, et al. Association of left atrium voltage amplitude and distribution with the risk of atrial fibrillation recurrence and evolution after pulmonary vein isolation: An ultrahigh-density mapping study. J Cardiovasc Electrophysiol. 2019;30(8): 1231-1240. https://doi.org/10.1111/jce.13972.Ballesteros G, Ravassa S, Bragard J, et al. Association of left atrium voltage amplitude and distribution with the risk of atrial fibrillation recurrence and evolution after pulmonary vein isolation: An ultrahigh-density mapping study. J Cardiovasc Electrophysiol. 2019;30(8): 1231-1240. https://doi.org/10.1111/jce.13972.

The authors declare that there are no conflicts of interest present.