| Objective:The purpose of this study was to compare the effectiveness of voltage mapping and impedance mapping assisted by three-dimensional electroanatomic mapping system in guiding transseptal puncture,so as to provide an optimal solution for zeroray TSP.Methods:The subjects were 40 patients who were diagnosed with atrial fibrillation in the First Affiliated Hospital of Nanchang University from September 2021 to March 2023 and received radiofrequency ablation under the guidance of Johnson Company 3DEAM system(Carto3 system).In each patient,the fossa oval was marked by voltage and impedance with the assistance of Carto3 system,and the two-dimensional ultrasound image of the fossa oval was obtained by intracardiac ultrasound.The clinical baseline data of the patients and the voltage and impedance values obtained when the fossa oval was marked by voltage / impedance were collected.Pearson correlation analysis was used to explore the correlation between voltage value and impedance value and catheter contact pressure during mapping.Wilcoxon two-sample rank sum test was used to analyze whether there was a statistical difference in the distribution of fossa oval and its surrounding voltage and impedance values.The reference values of the voltage and impedance of the fossa oval were obtained by statistical analysis of the voltage / impedance measured by the receiver operating curve.The voltage and impedance reference values of the fossa oval obtained by the ROC curve were plotted in the Carto3 system to draw the specific morphology of the fossa oval under the two mapping methods.Finally,the advantages and disadvantages of 3D-EAM-assisted voltage mapping and impedance mapping in guiding zero-ray transseptal puncture were analyzed by comparing the area of the fossa oval measured by voltage / impedance mapping and the overlapping area of the fossa oval under concentric ultrasound.Result:1.Linear correlation analysis(Pearson analysis)showed that there was no significant difference in the correlation between catheter contact pressure(g)and atrial septal voltage(r =-0.070,P = 0.568),and there was no significant difference in the correlation between catheter contact pressure and atrial septal impedance(r =-0.111,P = 0.365).2.Wilcoxon two sample rank sum test.After the test,the median fossa oval peripheral voltage group was 1.30(0.82,1.96)mv,and the median fossa oval voltage group was 0.42(0.23,0.54)mv.There was a statistical difference in the distribution of voltage values between the two groups(z =-6.557,P < 0.001).There was no significant difference in the distribution of impedance values between the two groups(z =-1.817,P = 0.069).The median of the peripheral impedance group was 128.0(123,136)and the median of the fossa oval impedance group was 124.5(120,132).3.The patient ’s voltage value and impedance value were divided into the fossa oval group and the fossa oval peripheral group for ROC curve.The area under the curve of the voltage group was 0.967(95 % CI 0.934-1.000,P < 0.001).When the voltage value was 0.665 mv,the sensitivity was 87.8 % and the specificity was 92.9 %.The area under the curve of the impedance group was 0.629(95 % CI 0.496-0.763,P = 0.070).When the impedance value was 126.5Ω,the sensitivity was 61.0 % and the specificity was 60.7 %.4.Voltage mapping FO area(cm~2)Mean ± SD : 3.88 ± 1.413,Impedance mapping FO area(cm~2)Mean ± SD : 4.30 ± 1.723,Voltage mapping and ICE direct vision FO overlap area(cm~2)Mean ± SD : 2.55 ± 0.536,Impedance mapping and ICE direct vision FO overlap area(cm~2)Mean ± SD : 1.62 ± 0.117.Conclusion:Voltage mapping assisted by three-dimensional electroanatomical system is superior to impedance mapping in guiding zero-ray atrial septal puncture. |
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