Skip to main content
SpringerLink
Log in

Mapping und Ablation von Herzrhythmusstörungen

„Never forget where you are coming from“

Mapping and ablation of cardiac arrhythmias

Never forget where you are coming from

  • Schwerpunkt
  • Published:
Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Dank des stetigen technischen Fortschritts und einer kontinuierlichen Weiterentwicklung der dreidimensionalen Mapping-Systeme haben sich das Verständnis und die interventionellen Möglichkeiten der Katheterablation bei Herzrhythmusstörungen stetig verbessert. Die entscheidende Voraussetzung für eine erfolgreiche Ablation ist die exakte Identifizierung des Tachykardiemechanismus und anschließend die Lokalisation des Ursprungs bzw. des kritischen Tachykardiesubstrats. Dazu liefern ausschließlich intrakardiale Elektrogramme die entscheidenden Informationen hinsichtlich Aktivierungszeit und Morphologie des Signals. Bei einigen Arrhythmien ist es notwendig, das konventionelle Signal-Mapping um das sog. Pace- und/oder Entrainment-Mapping zu ergänzen. Dieser Artikel zeigt anhand einiger sorgfältig ausgewählter klinischer Fallbeispiele wichtige Komponenten des Mappings von Herzrhythmusstörungen und soll auf diesem Wege den Stellenwert der direkt vom Katheter abgeleiteten Signale hervorheben. Die modernen 3‑D-Mapping-Verfahren ermöglichen, individuell etablierte Ablationsstrategien mit einer deutlich besseren räumlichen Auflösung zu optimieren. Trotzdem bleibt aus Sicht der Autoren die Interpretation der intrakardialen Elektrogramme und der vom Katheter abgeleiteten Signale weiterhin zentraler Bestandteil der elektrophysiologischen Untersuchung, des Mappings und auch der erfolgreichen und sicheren Ablation von Herzrhythmusstörungen.

Abstract

With the rapid development of new mapping and imaging technologies as well as catheter ablation technologies, it is increasingly important to understand the basic concepts of conventional mapping and ablation of cardiac arrhythmias. Prerequisite for successful ablation is the exact identification of the tachycardia mechanism and subsequent localization of the origin or tachycardic substrate. Only intracardiac electrograms provide decisive information regarding activation time and signal morphology. In some arrhythmias, it is necessary to supplement conventional mapping with so-called pace and/or entrainment mapping. This article aims to discuss and demonstrate the fundamentals of intracardiac mapping as it relates to the mapping and ablation of supraventricular and ventricular arrhythmias based on representative clinical cases. Modern three-dimensional mapping methods make it possible to individually optimize established ablation strategies with significantly better spatial resolution. The authors aimed to demonstrate that intracardiac uni- and bipolar electrograms provide essential information about timing and morphology guiding successful catheter ablation. Furthermore, our article provides useful information about conventional cardiac mapping techniques including activation mapping, pace mapping, and individual substrate mapping.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Arruda MS, McClelland JH, Wang X et al (1998) Development and validation of an ECG algorithm for identifying accessory pathway ablation site in Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol 9:2–12

    Article  CAS  PubMed  Google Scholar 

  2. von Bary C, Eckardt L, Steven D et al (2015) AV nodal reentrant tachycardia. Diagnosis and therapy. Herzschrittmacherther Elektrophysiol 26(4):351–358. https://doi.org/10.1007/s00399-015-0399-x

    Article  Google Scholar 

  3. Cassidy DM, Vassallo JA, Buxton AE et al (1984) The value of catheter mapping during sinus rhythm to localize site of origin of ventricular tachycardia. Circulation 69:1103–1110

    Article  CAS  PubMed  Google Scholar 

  4. Haïssaguerre M, Shah DC, Jaïs P et al (2002) Role of Purkinje conducting system in triggering of idiopathic ventricular fibrillation. Lancet 359(9307):677–678. https://doi.org/10.1016/S0140-6736(02)07807-8

    Article  PubMed  Google Scholar 

  5. Harrison JL, Sohns C, Linton NW et al (2015) Repeat left atrial catheter ablation: cardiac magnetic resonance prediction of endocardial voltage and gaps in ablation lesion sets. Circ Arrhythm Electrophysiol 8:270–278. https://doi.org/10.1161/CIRCEP.114.002066

    Article  PubMed  Google Scholar 

  6. Huang SKS, Miller JM (2015) Catheter ablation of cardiac arrhythmias, 3. Aufl. Elsevier Saunders, Philadelphia

    Google Scholar 

  7. Kinoshita O, Fontaine G, Rosas F et al (1995) Time- and frequency-domain analyses of the signal-averaged ECG in patients with arrhythmogenic right ventricular dysplasia. Circulation 91:715–721

    Article  CAS  PubMed  Google Scholar 

  8. Kuo CT, Lin KH, Cheng NJ et al (1999) Characterization of atrioventricular nodal reentry with continuous atrioventricular node conduction curve by double atrial extrastimulation. Circulation 99:659–665

    Article  CAS  PubMed  Google Scholar 

  9. Laplante L, Benzaquen BS (2016) A review of the potential pathogenicity and management of frequent premature ventricular contractions. Pacing Clin Electrophysiol 39(7):723–730. https://doi.org/10.1111/pace.12870

    Article  PubMed  Google Scholar 

  10. Man KC, Daoud EG, Knight BP et al (1997) Accuracy of the unipolar electrogram for identification of the site of origin of ventricular activation. J Cardiovasc Electrophysiol 8:974–979

    Article  CAS  PubMed  Google Scholar 

  11. Marrouche NF, Wilber D, Hindricks G et al (2014) Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA 311:498–506. https://doi.org/10.1001/jama.2014.3

    Article  CAS  PubMed  Google Scholar 

  12. Nogami A, Sugiyasu A, Kubota S, Kato K (2005) Mapping and ablation of idiopathic ventricular fibrillation from the Purkinje system. Heart Rhythm 2:646–649. https://doi.org/10.1016/j.hrthm.2005.02.006

    Article  PubMed  Google Scholar 

  13. Nührich JM, Kaiser L, Akbulak RÖ et al (2017) Substrate characterization and catheter ablation in patients with scar-related ventricular tachycardia using ultra high-density 3‑D mapping. J Cardiovasc Electrophysiol 28:1058–1067. https://doi.org/10.1111/jce.13270

    Article  PubMed  Google Scholar 

  14. Orejarena LA, Vidaillet H, DeStefano F et al (1998) Paroxysmal supraventricular tachycardia in the general population. J Am Coll Cardiol 31:150–157

    Article  CAS  PubMed  Google Scholar 

  15. Rottner L, Metzner A, Ouyang F et al (2017) Direct comparison of point-by-point and rapid ultra-high-resolution Electroanatomical mapping in patients scheduled for ablation of atrial fibrillation. J Cardiovasc Electrophysiol 28:289–297. https://doi.org/10.1111/jce.13160

    Article  PubMed  Google Scholar 

  16. Schaeffer B, Hoffmann BA, Meyer C et al (2016) Characterization, mapping, and ablation of complex atrial tachycardia: initial experience with a novel method of ultra high-density 3D mapping. J Cardiovasc Electrophysiol 27:1139–1150. https://doi.org/10.1111/jce.13035

    Article  PubMed  Google Scholar 

  17. Sohns C, Saguner AM, Lemes C et al (2016) First clinical experience using a novel high-resolution electroanatomical mapping system for left atrial ablation procedures. Clin Res Cardiol 105:992–1002. https://doi.org/10.1007/s00392-016-1008-7

    Article  PubMed  Google Scholar 

  18. Swissa M, Birk E, Dagan T et al (2017) Radiofrequency catheter ablation of atrioventricular node reentrant tachycardia in children with limited fluoroscopy. Int J Cardiol 236:198–202. https://doi.org/10.1016/j.ijcard.2017.01.128

    Article  PubMed  Google Scholar 

  19. Wolff L, Parkinson J, White PD (2006) Bundle-branch block with short P‑R interval in healthy young people prone to paroxysmal tachycardia. 1930. Ann Noninvasive Electrocardiol 11:340–353. https://doi.org/10.1111/j.1542-474X.2006.00127.x

    Article  PubMed  Google Scholar 

  20. Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE) (2017) European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias. Europace 19:659. https://doi.org/10.1093/europace/euw444

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Elektrophysiologie Bremen, Senator-Weßling-Str. 1, 28277, Bremen, Deutschland

    Henning Jansen, Jürgen Siebels, Rodolfo Ventura, Joachim Hebe &  Christian Sohns

Authors
  1. Henning Jansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jürgen Siebels
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rodolfo Ventura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joachim Hebe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christian Sohns
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Sohns.

Ethics declarations

Interessenkonflikt

H. Jansen, J. Siebels, R. Ventura, J. Hebe und C. Sohns geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jansen, H., Siebels, J., Ventura, R. et al. Mapping und Ablation von Herzrhythmusstörungen. Herzschr Elektrophys 29, 246–253 (2018). https://doi.org/10.1007/s00399-018-0577-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00399-018-0577-8

Schlüsselwörter

Keywords

Search

Navigation