Sinus-rhythm electroanatomic mapping correlated with the presence of post-infarct scars, but showed a clear mismatch in infarct surface compared to MRI in one-third of infarct zones.
Observational (n=10)
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 (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.
Codreanu et al. (2008) conducted an observational in Post-infarct ventricular tachycardia (n=10). Electroanatomic mapping (EAM) vs. Magnetic resonance imaging (MRI) with delayed contrast enhancement (DCE) was evaluated on Delineation of post-infarct scars (correlation of EGM characteristics with scar data). Sinus-rhythm electroanatomic mapping correlated with the presence of post-infarct scars, but showed a clear mismatch in infarct surface compared to MRI in one-third of infarct zones.