Key result
Contact-force EAM identifies lower subtricuspid bipolar voltage in ARVC, yielding 78% AUC.
Why the study?
Previous studies using electroanatomical mapping have not systematically used contact-force sensing catheters to characterize the substrate in ARVC.
Does endocardial right ventricular electroanatomical mapping with contact force sensing catheters differentiate patients with arrhythmogenic right ventricular cardiomyopathy from healthy controls?
Case-Control (n=17)
Does endocardial right ventricular electroanatomical mapping with contact force sensing catheters differentiate patients with arrhythmogenic right ventricular cardiomyopathy from healthy controls?
Effect estimate: AUC 78% (95% CI 0.75-0.81)
Absolute Event Rate: 1.4% vs 3.8%
p-value: p=<0.001
Electroanatomical mapping using contact-force sensing catheters identifies lower right ventricular voltages in ARVC patients, particularly in the subtricuspid area, offering a promising diagnostic tool.
CFSC-guided RV EAM may aid ARVC diagnosis via subtricuspid voltage thresholds; leaves open prospective validation in larger cohorts.
BACKGROUND: Three-dimensional electroanatomical mapping (EAM) can be helpful to diagnose arrhythmogenic right ventricular cardiomyopathy (ARVC). Yet, previous studies utilizing EAM have not systematically used contact-force sensing catheters (CFSC) to characterize the substrate in ARVC, which is the current gold standard to assure adequate tissue contact. OBJECTIVE: To investigate reference values for endocardial right ventricular (RV) EAM as well as substrate characterization in patients with ARVC by using CFSC. METHODS: Endocardial RV EAM during sinus rhythm was performed with CFSC in 12 patients with definite ARVC and 5 matched controls without structural heart disease. A subanalysis for the RV outflow tract (RVOT), septum, free-wall, subtricuspid region, and apex was performed. Endocardial bipolar and unipolar voltage amplitudes (BVA, UVA), signal characteristics and duration as well as the impact of catheter orientation on endocardial signals were also investigated. RESULTS: ARVC patients showed lower BVA vs. controls (p = 0.018), particularly in the subtricuspid region (1.4, IQR:0.5-3.1 vs. 3.8, IQR:2.5-5 mV, p = 0.037) and RV apex (2.5, IQR:1.5-4 vs. 4.3,IQR:2.9-6.1 mV, p = 0.019). BVA in all RV regions yielded a high sensitivity and specificity for ARVC diagnosis (AUC 59-78%, p < 0.05 for all), with the highest performance for the subtricuspid region (AUC 78%, 95% CI:0.75-0.81, p < 0.001, negative predictive value 100%). A positive correlation between BVA and an orthogonal catheter orientation (46°-90°:r = 0.106, p < 0.001), and a negative correlation between BVA and EGM duration (r = -0.370, p < 0.001) was found. CONCLUSIONS: EAM using CFSC validates previous bipolar cut-off values for normal endocardial RV voltage amplitudes. RV voltages are generally lower in ARVC as compared to controls, with the subtricuspid area being commonly affected and having the highest discriminatory power to differentiate between ARVC and healthy controls. Therefore, EAM using CFSC constitutes a promising tool for diagnosis of ARVC.
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Saguner et al. (2023) conducted a case-control in Arrhythmogenic right ventricular cardiomyopathy (ARVC) (n=17). Endocardial right ventricular electroanatomical mapping with contact-force sensing catheters vs. Matched controls without structural heart disease was evaluated on Bipolar voltage amplitude (BVA) in the subtricuspid region (AUC 78%, 95% CI 0.75-0.81, p=<0.001). Electroanatomical mapping with contact-force sensing catheters identified lower bipolar voltage amplitudes in ARVC patients, with the subtricuspid region yielding an AUC of 78% (95% CI 0.75-0.81).
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