Manual LAVA-based voltage mapping performed better than automatic mapping for delineating low-voltage areas, showing higher overlap with DE-MRI scar area (76% vs 45%; P=0.04).
Observational (n=12)
Does manual LAVA-based voltage mapping improve scar delineation compared to automatic mapping in postmyocarditis patients with epicardial-only scar?
In postmyocarditis patients with epicardial-only scar, manual LAVA-based voltage mapping provides significantly better scar delineation than automatic mapping, emphasizing the necessity of epicardial access and careful mapping.
Absolute Event Rate: 76% vs 45%
p-value: p=0.04
BACKGROUND: Nonischemic cardiomyopathy is a heterogeneous condition providing a favorable substrate for ventricular tachycardia (VT). OBJECTIVE: The purpose of this study is to further characterize the substrate in a subset of postmyocarditis patients with epicardial-only scar. METHODS: Twelve postmyocarditis patients (11 male, 49 ± 14 years, left ventricular ejection fraction 49 ± 12%) with VT and epicardial-only scar were included for analysis comparing automatic high-amplitude normal activity (HANA) maps to manually adjusted maps of based on local abnormal ventricular activity (LAVA) electrograms when present. A combined endocardial (endo) and epicardial (epi) approach was used in 11/12 with usual bipolar/unipolar voltage thresholds and analyzed using image integration. RESULTS: A delayed enhancement MRI scar area of 52 cm(2) (38, 59) and multidetector CT wall thinning area of 18 cm(2) (14, 35) was found. Bipolar voltage substrate mapping (160 points 101, 239 endo, 553 points 232, 713 epi and LAVA were found only epicardially 443 LAVA points in all) illustrated a low-voltage area of HANA: 1 cm(2) (0, 10) endo, 25 cm(2) (22, 39) epi and LAVA: 1 cm(2) (0, 10) endo, 39 cm(2) (28, 51) epi. Manual maps performed better than automatic maps for delineating low-voltage area with a higher overlap with scar area on delayed enhancement magnetic resonance imaging (DE-MRI; 76% 66, 94 vs. 45% 35, 62; P = 0.04). In addition, manual voltage maps also showed a higher overlap with location of LAVA (LAVA in normal voltage area: 3% 0, 9 vs. 35% 32, 41; P < 0.05). CONCLUSION: In postmyocarditis patients with epicardial-only scar, automatic voltage mapping may miss or minimize the electrical VT substrate. DE-MRI and manual LAVA-based voltage mapping are necessary to optimize scar delineation. Epicardial access is critical for mapping and ablation in this condition.
Berte et al. (Wed,) conducted a observational in Postmyocarditis Ventricular Tachycardia (n=12). Manual LAVA-based voltage mapping vs. Automatic high-amplitude normal activity (HANA) mapping was evaluated on Overlap with scar area on delayed enhancement magnetic resonance imaging (DE-MRI) (p=0.04). Manual LAVA-based voltage mapping performed better than automatic mapping for delineating low-voltage areas, showing higher overlap with DE-MRI scar area (76% vs 45%; P=0.04).
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