Background and objectives

Macroreentrant atrial tachyarrhythmias (MRATs) can be caused by different reentrant circuits. The treatment for each MRAT type may require ablation at different sites, either at the right or left atria. Unfortunately, the reentrant circuit that drives the arrhythmia cannot be ascertained previous to the electrophysiological intervention.

Methods

A noninvasive approach based on the comparison of atrial vectorcardiogram (VCG) loops is proposed. An archetype for each group was created, which served as a reference to measure the similarity between loops. Methods were tested in a variety of simulations and real data obtained from the most common right (peritricuspid) and left (perimitral) macroreentrant circuits, each divided into clockwise and counterclockwise subgroups. Adenosine was administered to patients to induce transient AV block, allowing the recording of the atrial signal without the interference of ventricular signals. From the vectorcardiogram, we measured intrapatient loop consistence, similarity of the pathway to archetypes, characterisation of slow velocity regions and pathway complexity.

Results

Results show a considerably higher similarity with the loop of its corresponding archetype, in both simulations and real data. We found the capacity of the vectorcardiogram to reflect a slow velocity region, consistent with the mechanisms of MRAT, and the role that it plays in the characterisation of the reentrant circuit. The intra-patient loop consistence was over 0.85 for all clinical cases while the similarity of the pathway to archetypes was found to be 0.85 $\pm$ 0.03, 0.95 $\pm$ 0.03, 0.87 $\pm$ 0.04 and 0.91 $\pm$ 0.02 for the different MRAT types (and $p<0.02$ for 3 of the 4 groups), and pathway complexity also allowed to discriminate among cases (with $p<0.05$).

Conclusions

We conclude that the presented methodology allows us to differentiate between the most common forms of right and left MRATs and predict the existence and location of a slow conduction zone. This approach may be useful in planning ablation procedures in advance.

中文翻译：

---

通过以慢传导区为基石的矢量心电图方法对大折返性心动过速类型进行无创性表征

背景和目标

大肠折返性房性心律失常（MRAT）可能由不同的折返回路引起。每种MRAT类型的治疗可能需要在右心房或左心房的不同部位进行消融。不幸的是，在电生理干预之前无法确定驱动心律不齐的折返回路。

方法

提出了一种基于心房心电图（VCG）回路比较的非侵入性方法。创建每个组的原型，以作为测量循环之间相似性的参考。方法在各种模拟中进行了测试，并从最常见的右（边缘）和左（边缘）大凹入电路（分别分为顺时针和逆时针子组）获得了真实数据。向患者施用腺苷以诱导短暂性房室传导阻滞，从而可以记录心房信号而不会干扰心室信号。根据矢量心电图，我们测量了患者内环的一致性，原型与途径的相似性，慢速区域的特征以及途径的复杂性。

结果

结果显示，在模拟和实际数据中，与其相应原型的循环都具有更高的相似性。我们发现矢量心电图反映慢速区域的能力与MRAT的机制一致，并且在折返电路的表征中也发挥了作用。所有临床病例的患者环内一致性均超过0.85，而原型发现途径的相似度为0.85 $\pm$ 0.03、0.95 $\pm$ 0.03、0.87 $\pm$ 0.04和0.91 $\pm$ 不同的MRAT类型为0.02（和 $p<0.02$ （4组中的3组），并且路径复杂度也可以区分病例（ $p<0.05$）。

结论

我们得出结论，提出的方法使我们能够区分最常见的右MRAT和左MRAT形式，并预测慢传导区的存在和位置。该方法在预先计划消融程序中可能有用。