The impact of selecting activation timing based on peak-frequency calculated by omnipolar technology on 3D-mapping

• Project/Area Number: 20K17074
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 53020:Cardiology-related
• Research Institution: Tokyo Medical and Dental University
• Principal Investigator: Takigawa Masateru 東京医科歯科大学, 大学院医歯学総合研究科, 寄附講座助教 (40760062)
• Project Period (FY): 2020-04-01 – 2023-03-31
• Project Status: Completed (Fiscal Year 2022)
• Budget Amount: ¥4,290,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥990,000); Fiscal Year 2021: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000); Fiscal Year 2020: ¥2,860,000 (Direct Cost: ¥2,200,000、Indirect Cost: ¥660,000)
• Keywords: 局所電位 / 周波数 / 電位高 / オムニポーラー / 双極電位 / 局所興奮 / peak-frequency / 電位 / Omnipolar / 三次元マッピング / 三次元マッピングシステム / 多点同時マッピング

Outline of Research at the Start

技術革新に伴い不整脈領域のアブレーション治療は、急激に進歩した。とりわけ高密度多点同時マッピングシステムの開発により、不整脈基質の解析がより迅速に正確に行われるようになった。しかしながら、局所の電位は周辺からのFar-field電位と、真の局所のNear-field電位の複合情報により規定され、それらは電極配置と興奮伝導の方向に応じて変化するため、自動的に局所の電位情報を獲得するには依然限界がある。
本研究の目的は、Omnipolarカテーテルを用い、周辺のUnipolarの電位から、仮想Bipolar電位を算出し、周波数解析で真の局所電位を決定するいうアルゴリズムの有効性を証明することである。

Outline of Final Research Achievements

Usually, local activation timing is demonstrated by the dv/dt of bipolar voltages, so that it is frequently affected by the bipolar amplitudes. In such case, large far-field effect may mask the activation of the small musculature close to the large volume of healthy muscle. The novel algorithm, using omnipolar technology calculate the peak-frequency of the local electrogram, and define the local activation timing as the sharpest segment in the electrogram. This may enable to detect the gap more accurately, and show the activation more precisely. However, the results showed that not a remarkable difference was observed between the dv/dt-based map and peak-frequency based map.

Academic Significance and Societal Importance of the Research Achievements

電位高は、本領域において長く使用されてきたパラメータである。例えば、双極電位で心房電位＜0.5mV、心室電位＜1.5mVは異常低電位領域とされてきたが、これはかなり経験的に決めれられたにもかかわらず、長く臨床においても使用されている。しかしながら、peak-frequencyは電位高とは、正常値における分布も異なっており、同様の情報を表しているものではない。この新たな指標を相補的に使用することにより、複雑な不整脈の機序の解明に役立つ可能性がある。

Research Products

• [Journal Article] Confirmation of the achievement of linear lesions using “activation vectors” based on omnipolar technology (2022)
  • Author(s): Takigawa Masateru、Goya Masahiko、Ikenouchi Takashi、Shimizu Yuki、Amemiya Miki、Kamata Tatsuaki、Nishimura Takuro、Tao Susumu、Takahashi Yoshihide、Miyazaki Shinsuke、Sasano Tetsuo
  • Journal Title: Heart Rhythm Volume: 19 Issue: 11 Pages: 1792-1801
  • DOI: 10.1016/j.hrthm.2022.07.026
  • Peer Reviewed
• [Journal Article] Differentiating atrial tachycardias with centrifugal activation: Lessons from high-resolution mapping (2021)
  • Author(s): Takigawa M, Takagi T, Martin CA, Derval N, Denis A, Vlachos K, Cheniti G, Duchateau J, Pambrun T, Shirai Y, Tao S, Takahashi Y, Goya M, Sacher F, Cochet H, Hocini M, Haissaguerre M, Sasano T, Jais P.
  • Journal Title: Heart Rhythm Journal Volume: - Issue: 7 Pages: 1122-1131
  • DOI: 10.1016/j.hrthm.2021.03.038
  • Peer Reviewed
• [Journal Article] Clinical implications of local impedance measurement using the IntellaNav MiFi OI ablation catheter: an ex vivo study (2021)
  • Author(s): Iwakawa Hidehiro、Takigawa Masateru、Goya Masahiko、Iwata Toyoto、Martin Claire A.、Anzai Tatsuhiko、Takahashi Kunihiko、Amemiya Miki、Yamamoto Tasuku、Sekigawa Masahiro、Shirai Yasuhiro、Tao Susumu、Hayashi Tatsuya、Takahashi Yoshihide、Watanabe Hiroyuki、Sasano Tetsuo
  • Journal Title: Journal of Interventional Cardiac Electrophysiology Volume: - Issue: 1 Pages: 185-195
  • DOI: 10.1007/s10840-021-00954-8
  • Peer Reviewed
• [Presentation] 電位に着目したEnsiteXTMシステムを活用して、心房細動治療に挑む!新たなパラメーター ‘Peak-Frequency’の活用 (2023)
  • Author(s): 滝川正晃
  • Organizer: 日本不整脈心電学会（ベリタスHRS)
• [Presentation] Effect of Activation Direction on Peak-Frequency of Local Electrograms (2022)
  • Author(s): Masateru Takigawa, Masahiko Goya, Miho Negishi, Tasuku Yamamoto, Takashi Ikenouchi, Takatoshi Shigeta, Kentaro Goto, Takuro Nishimura, Susumu Tao, Shinsuke Miyazaki, Tetsuo Sasano
  • Organizer: Japanease Circulation Society Scientific Session 2023
• [Presentation] Normal distribution of peak-frequency of near-field electrograms in right and left atriums (2022)
  • Author(s): Masateru Takigawa, Masahiko Goya, Yuki Shimizu, Miki Amemiya, Tasuku Yamamoto, Takashi Ikenouchi, Rena Nakamura, Tatsuaki Kamata, Takuro Nishimura, Susumu Tao, Shinsuke Miyazaki, Tetsuo Sasano
  • Organizer: Japanease Circulation Society Scientific Session 2022
• [Presentation] Closing the Gaps in Lesions with Omnipolar Vectors and Novel Ablation Technology (2022)
  • Author(s): Masateru Takigawa
  • Organizer: Asia Pacific Heart Rhythm Society Scientific Session 2022
  • Int'l Joint Research / Invited
• [Presentation] Innovating Toward a New Era For Mapping and Ablation Technology in AF treatment to my practice and what should you know - (2022)
  • Author(s): Masateru Takigawa
  • Organizer: Asia Pacific Heart Rhythm Society Scientific Session 2022
  • Invited
• [Presentation] Normal distribution of peak-frequency of nerf-field electrograms in right and left atriums (2021)
  • Author(s): 滝川正晃
  • Organizer: 日本循環器学会
• [Presentation] Clinical implications of local impedance measurement using the IntellaNav MiFi OI ablation catheter: an ex vivo study (2020)
  • Author(s): Iwakawa H, Takigawa M, Goya M, Iwata T, Martin CA, Anzai T, Takahashi K, Amemiya M, Yamamoto T, Sekigawa M, Shirai Y, Tao S, Hayashi T, Takahashi Y, Watanabe H, Sasano T
  • Organizer: Heart Rhythm 2020
  • Int'l Joint Research
• [Presentation] The impact of the novel formula combining local impedance and conventional parameters on the prediction of lesion size (2020)
  • Author(s): Takigawa M, Goya M,Iwakawa H, Kamata T, Matsumura Y, Amemiya M, Yamamoto T, Hirao T, Sekigawa M, Shirai Y, Tao S, Hayashi T, Takahashi Y,Sasano T
  • Organizer: 第85回日本循環器学会総会