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J Am Coll Cardiol. 2008 Sep 2;52(10):839-42. doi: 10.1016/j.jacc.2008.05.038.

Electroanatomic characterization of post-infarct scars comparison with 3-dimensional myocardial scar reconstruction based on magnetic resonance imaging.

Author information

1
Department of Cardiology, University Hospital Nancy, Nancy, France.

Abstract

OBJECTIVES:

This study was designed to compare electroanatomic mapping (EAM) and magnetic resonance imaging (MRI) with delayed contrast enhancement (DCE) data for delineation of post-infarct scars.

BACKGROUND:

Electroanatomic substrate mapping is an important step in the post-infarct ventricular tachycardia (VT) ablation strategy, but this technique has not yet been compared with a gold-standard noninvasive tool informing on the topography and transmural extent of myocardial scars in humans.

METHODS:

Ten patients (9 men, age 71 +/- 10 years) admitted for post-infarct VT ablation underwent both a left ventricle DCE MRI and a sinus-rhythm 3-dimensional (3D) (CARTO) EAM (Biosense Webster, Johnson & Johnson, Diamond Bar, California). A 3D color-coded MRI-reconstructed left ventricular endocardial shell was generated to display scar data (intramural location and transmural extent). A matching process allocated any CARTO point to its corresponding position on the MRI map. Electrogram (EGM) characteristics were then evaluated in relation to scar data.

RESULTS:

A spiky EGM morphology, a reduced unipolar or bipolar EGM voltage amplitude (<6.52 and <1.54 mV, respectively), as well as a longer bipolar EGM duration (>56 ms) independently correlated with the presence of scar whatever its intramural position. Endocardial scars had a larger degree of signal reduction than intramural or epicardial scars. None of the parameters was correlated with transmural scar depth. A clear mismatch in infarct surface between CARTO and MRI maps was observed in one-third of infarct zones.

CONCLUSIONS:

Sinus-rhythm EAM helps identify the limits of post-infarct scars. However, the accuracy of EAM for precise scar delineation is limited. This limit might be circumvented using anatomical information provided by 3D MRI data.

PMID:
18755347
DOI:
10.1016/j.jacc.2008.05.038
[Indexed for MEDLINE]
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