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J Cardiovasc Electrophysiol. 2019 Jan 4. doi: 10.1111/jce.13842. [Epub ahead of print]

Three-Dimensional Myocardial Scar Characterization from the Endocardium: Usefulness of Endocardial Unipolar Electroanatomic Mapping.

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Hospital Germans Trias i Pujol, Badalona, Spain.
Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, U.S.A.


Epicardial ablation may be required to eliminate ventricular tachycardia (VT) in patients with underlying structural heart disease. The decision to gain epicardial access is frequently based on the suspicion of an epicardial origin for the VT and/or presence of an arrhythmogenic substrate. Epicardial pathology and VT is frequently present in patients with non-ischemic right and/or left cardiomyopathies even in the setting of modest or no endocardial bipolar voltage substrate. In this setting, unipolar voltage mapping from the endocardium serves to help identify mid-myocardial and/or epicardial VT substrate. Additional value of endocardial unipolar mapping includes its usefulness to predict the clinical outcome after VT ablation, to determine irreversibility of myocardial disease and to guide endomyocardial biopsy procedures to specific areas of intra-mural scarring. In this review we aim to provide a guide to the use of endocardial unipolar mapping and its appropriate interpretation in a variety of clinical situations. This article is protected by copyright. All rights reserved.


cardiomyopathy; electroanatomic mapping; unipolar electrogram; ventricular tachycardia


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