What is the clinical evidence from this study?

Study design: Observational. Population: Right epicardial ventricular tachycardia (n=20). Intervention: Endocardial unipolar peak-negative voltage mapping. Primary outcome: Presence of epicardial dense scar, low voltage zones, and ablation targets.

What does this research mean for the field?

Endocardial unipolar peak-negative voltage <1.66 mV predicts the presence of overlying epicardial dense scar with 89% sensitivity and 53% specificity in patients with right epicardial ventricular tachycardia. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 28, 2014

Unipolar Peak‐Negative Voltage as an Endocardial Electrographic Characteristic to Predict Overlying Abnormal Epicardial Substrates in Patients with Right Epicardial Ventricular Tachycardia

Key Result

Endocardial unipolar peak-negative voltage <1.66 mV predicted the presence of overlying epicardial dense scar with 89% sensitivity and 53% specificity in patients with RV epicardial VT.

Study Design

Type

Observational (n=20)

Structured PICO

Does endocardial unipolar peak-negative voltage predict overlying abnormal epicardial substrates in patients with right epicardial ventricular tachycardia?

Population

20 consecutive patients (median age: 46 years, 11 men) undergoing epicardial VT ablation for arrhythmogenic right ventricular cardiomyopathy with epicardial ventricular tachycardia (VT).

Intervention

Endocardial electrographic mapping (unipolar peak-to-peak voltage, unipolar peak-negative-voltage, bipolar voltage, and bipolar electrogram duration) using the CARTO 3 system

Outcome

Presence of epicardial dense scar (<0.5 mV), low voltage zones (LVZ; ≤1.5 mV), and ablation targetssurrogate

Endocardial unipolar peak-negative voltage <1.66 mV is a useful marker to predict overlying epicardial dense scar and ablation targets in patients with right epicardial VT.

Abstract

INTRODUCTION: The characteristics of endocardial electrograms needed to detect the overlying abnormal epicardial substrates in arrhythmogenic right ventricular cardiomyopathy with epicardial ventricular tachycardia (VT) remain unclear. This study investigated which of the endocardial electrogram characteristics could predict the overlying abnormal epicardial substrates. METHODS AND RESULTS: In 20 consecutive patients (median age: 46 years, 11 men) undergoing epicardial VT ablation, detailed endocardial and epicardial mappings were obtained by using the CARTO 3 system. The endocardial electrographic characteristics (unipolar peak-to-peak voltage, unipolar peak-negative-voltage, bipolar voltage, and bipolar electrogram duration) of the opposite endocardium and epicardium in RV were retrospectively investigated (N = 1,697 paired points, 84 ± 60 pairs/patient). Endocardial predictors of the presence of epicardial dense scar (<0.5 mV), low voltage zones (LVZ; ≤1.5 mV), and ablation targets (by using activation mapping, entrainment mapping, and pace mapping) were analyzed. RESULTS: In the multivariable analysis, (1) unipolar peak-negative voltage independently predicted the presence of epicardial LVZ, epicardial dense scar, and ablation targets; (2) bipolar voltage could not predict epicardial lesions; and (3) bipolar electrogram duration predicted epicardial LVZ, but not dense scar or ablation targets. The endocardial unipolar peak-negative voltage of <1.66 mV (89% sensitivity and 53% specificity) was the optimal cutoff point for predicting epicardial dense scar. CONCLUSIONS: In patients with RV epicardial VT, the presence of unipolar peak-negative voltage of <1.66 mV in the endocardium predicted the presence of epicardial dense scar (<0.5 mV) and potential ablation targets in the overlying epicardium.

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