- Poster presentation
- Open Access
Detection of intramural scar by electroanatomic mapping versus MRI in patients with non-ischemic cardiomyopathy
© Desjardins et al; licensee BioMed Central Ltd. 2013
- Published: 30 January 2013
- Myocardial Wall
- Remote Myocardium
- Electroanatomic Mapping
- Bipolar Voltage
- Myocardial Wall Thickness
Ventricular arrhythmias have been described to originate from intramural locations. Intramural scar can be assessed by delayed enhanced magnetic resonance imaging (DE-MRI ). The objective of this study was to determine whether endocardial voltage mapping by catheter can detect the presence and extent of scar deep within the myocardial wall thickness, using DE-MRI as gold standard.
On MRI, scar volume was 11.7±8.0 cm3, endocardial scar area was 19.3±13.4 cm2. Scar thickness was 4.6±0.7 mm (39±7% of wall thickness), with a subendocardial rim thickness of 3.3±1.6 mm (26±13%) and a subepicardial rim thickness of 4.8±2.6 mm (37±15%). Endocardial bipolar voltage measurements were 1.62±1.73 mV over the scar, 2.12±2.15 mV in a 1cm neighborhood around the scar, and 2.83±2.34 mV in the more remote myocardium (p<0.0001). Endocardial unipolar voltage measurements were 4.94±3.25 mV over the scar, 6.59±3.81 mV in a 1cm neighborhood around the scar, and 8.32±3.39 mV in the more remote myocardium (p<0.0001). Using ROC curves (Fig 1c,d) of the voltage maps, a unipolar cut-off value of 6.78 mV (AUC 0.78) and a bipolar cut-off value of 1.55 mV (AUC 0.69) best separated endocardial measurements overlying scar from the endocardial measurements more remote to the scar.
Although scar deep within the myocardial wall is far from the tip of the endocardial measurement catheter, its presence and extent can still be detected by endocardial electroanatomic mapping using a combination of unipolar and bipolar voltage, with unipolar voltage being more useful.
NIH K23 EB006481
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