Electroanatomic Characterization of Post-Infarct Scars

Codreanu, Andreï; Odille, Freddy; Aliot, Étienne; Marie, Pierre-Yves; Magnin‐Poull, Isabelle; Andronache, Marius; Mandry, Damien; Djaballah, W.; Régent, D; Felblinger, Jacques; Chillou, Christian de

doi:10.1016/j.jacc.2008.05.038

Cited by 191 publications

(45 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our results suggest that CMR may be helpful in this respect especially in avoiding areas of scar, which result in failure to capture or poor resynchronization. Targeting a late but not necessarily latest activating site (i.e., late but not within the scar) is achievable with CMR techniques that give information regarding myocardial activation/contraction patterns as well as pinpointing scar (24).…”

Section: Discussionmentioning

confidence: 99%

Optimized Left Ventricular Endocardial Stimulation Is Superior to Optimized Epicardial Stimulation in Ischemic Patients With Poor Response to Cardiac Resynchronization Therapy

Behar

Jackson

Hyde

et al. 2016

JACC: Clinical Electrophysiology

View full text Add to dashboard Cite

ObjectivesThe purpose of this study was to identify the optimal pacing site for the left ventricular (LV) lead in ischemic patients with poor response to cardiac resynchronization therapy (CRT).BackgroundLV endocardial pacing may offer benefit over conventional CRT in ischemic patients.MethodsWe performed cardiac magnetic resonance, invasive electroanatomic mapping (EAM), and measured the acute hemodynamic response (AHR) in patients with existing CRT systems.ResultsIn all, 135 epicardial and endocardial pacing sites were tested in 8 patients. Endocardial pacing was superior to epicardial pacing with respect to mean AHR (% change in dP/dtmax vs. baseline) (11.81 [-7.2 to 44.6] vs. 6.55 [-11.0 to 19.7]; p = 0.025). This was associated with a similar first ventricular depolarization (Q-LV) (75 ms [13 to 161 ms] vs. 75 ms [25 to 129 ms]; p = 0.354), shorter stimulation–QRS duration (15 ms [7 to 43 ms] vs. 19 ms [5 to 66 ms]; p = 0.010) and shorter paced QRS duration (149 ms [95 to 218 ms] vs. 171 ms [120 to 235 ms]; p < 0.001). The mean best achievable AHR was higher with endocardial pacing (25.64 ± 14.74% vs. 12.64 ± 6.76%; p = 0.044). Furthermore, AHR was significantly greater pacing the same site endocardially versus epicardially (15.2 ± 10.7% vs. 7.6 ± 6.3%; p = 0.014) with a shorter paced QRS duration (137 ± 22 ms vs. 166 ± 30 ms; p < 0.001) despite a similar Q-LV (70 ± 38 ms vs. 79 ± 34 ms; p = 0.512). Lack of capture due to areas of scar (corroborated by EAM and cardiac magnetic resonance) was associated with a poor AHR.ConclusionsIn ischemic patients with poor CRT response, biventricular endocardial pacing is superior to epicardial pacing. This may reflect accessibility to sites that cannot be reached via coronary sinus anatomy and/or by access to more rapidly conducting tissue. Furthermore, guidance to the optimal LV pacing site may be aided by modalities such as cardiac magnetic resonance to target delayed activating sites while avoiding scar.

show abstract

Section: Discussionmentioning

confidence: 99%

Optimized Left Ventricular Endocardial Stimulation Is Superior to Optimized Epicardial Stimulation in Ischemic Patients With Poor Response to Cardiac Resynchronization Therapy

Behar

Jackson

Hyde

et al. 2016

JACC: Clinical Electrophysiology

View full text Add to dashboard Cite

show abstract

“…4 and 5). Previous studies had shown that there could be significant areas of nonoverlap between scar visualized in voltage map and MRI,15 which may be attributed to suboptimal density of electrogram points. The high accuracy was validated by a comparison between electrograms from areas of different scar types that showed that the bipolar voltage recorded from the four scar types were statistically different.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Scar in Cardiac MRI and High‐Resolution Contact Mapping of Left Ventricle in a Chronic Infarct Model

Thajudeen

Jackman

Stewart

et al. 2015

Pacing Clinical Electrophis

View full text Add to dashboard Cite

BackgroundEndocardial mapping for scars and abnormal electrograms forms the most essential component of ventricular tachycardia ablation. The utility of ultra‐high resolution mapping of ventricular scar was assessed using a multielectrode contact mapping system in a chronic canine infarct model.MethodsChronic infarcts were created in five anesthetized dogs by ligating the left anterior descending coronary artery. Late gadolinium‐enhanced magnetic resonance imaging (LGE MRI) was obtained 4.9 ± 0.9 months after infarction, with three‐dimensional (3D) gadolinium enhancement signal intensity maps at 1‐mm and 5‐mm depths from the endocardium. Ultra‐high resolution electroanatomical maps were created using a novel mapping system (Rhythmia Mapping System, Rhythmia Medical/Boston Scientific, Marlborough, MA, USA) Rhythmia Medical, Boston Scientific, Marlborough, MA, USA with an 8.5F catheter with mini‐basket electrode array (64 tiny electrodes, 2.5‐mm spacing, center‐to‐center).ResultsThe maps contained 7,754 ± 1,960 electrograms per animal with a mean resolution of 2.8 ± 0.6 mm. Low bipolar voltage (<2 mV) correlated closely with scar on the LGE MRI and the 3D signal intensity map (1‐mm depth). The scar areas between the MRI signal intensity map and electroanatomic map matched at 87.7% of sites. Bipolar and unipolar voltages, compared in 592 electrograms from four MRI‐defined scar types (endocardial scar, epicardial scar, mottled transmural scar, and dense transmural scar) as well as normal tissue, were significantly different. A unipolar voltage of <13 mV correlated with transmural extension of scar in MRI. Electrograms exhibiting isolated late potentials (ILPs) were manually annotated and ILP maps were created showing ILP location and timing. ILPs were identified in 203 ± 159 electrograms per dog (within low‐voltage areas) and ILP maps showed gradation in timing of ILPs at different locations in the scar.ConclusionsUltra‐high resolution contact electroanatomical mapping accurately localizes ventricular scar and abnormal myocardial tissue in this chronic canine infarct model. The high fidelity electrograms provided clear identification of the very low amplitude ILPs within the scar tissue and has the potential to quickly identify targets for ablation.

show abstract

“…1 LE-MRI is an established modality and preferably used to identify regions of myocardial scar. 12–14 Defining myocardial scar and border zone using LE-MRI have been shown to facilitate substrate-guided ventricular tachycardia ablation. 15 However, its utility remains limited for patients with claustrophobia, inability to lie supine for prolonged periods or perform long breath holds, and generally contraindicated for patients with cardiac devices despite feasibility reports of its safety in such patients.…”

Section: Discussionmentioning

confidence: 99%

Myocardial scar imaging by standard single-energy and dual-energy late enhancement CT: Comparison with pathology and electroanatomic map in an experimental chronic infarct porcine model

Truong

Thai

Wai

et al. 2015

Journal of Cardiovascular Computed Tomography

View full text Add to dashboard Cite

Background Myocardial scar is a substrate for ventricular tachycardia and sudden cardiac death. Late enhancement computed tomography (CT) imaging can detect scar, but it remains unclear whether newer late enhancement dual-energy (LE-DECT) acquisition has benefit over standard single-energy late enhancement (LE-CT). Objective We aim to compare late enhancement CT using newer LE-DECT acquisition and single-energy LE-CT acquisitions to pathology and electroanatomical map (EAM) in an experimental chronic myocardial infarction (MI) porcine study. Methods In 8 chronic MI pigs (59±5 kg), we performed dual-source CT, EAM, and pathology. For CT imaging, we performed 3 acquisitions at 10 minutes post-contrast: LE-CT 80 kV, LE-CT 100 kV, and LE-DECT with two post-processing software settings. Results Of the sequences, LE-CT 100 kV provided the best contrast-to-noise ratio (all p≤0.03) and correlation to pathology for scar (ρ=0.88). While LE-DECT overestimated scar (both p=0.02), LE-CT images did not (both p=0.08). On a segment basis (n=136), all CT sequences had high specificity (87–93%) and modest sensitivity (50–67%), with LE-CT 100 kV having the highest specificity of 93% for scar detection compared to pathology and agreement with EAM (κ 0.69). Conclusions Standard single-energy LE-CT, particularly 100kV, matched better to pathology and EAM than dual-energy LE-DECT for scar detection. Larger human trials as well as more technical-based studies that optimize varying different energies with newer hardware and software are warranted.

show abstract

Electroanatomic Characterization of Post-Infarct Scars

Abstract: 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.

Cited by 191 publications

References 8 publications

Optimized Left Ventricular Endocardial Stimulation Is Superior to Optimized Epicardial Stimulation in Ischemic Patients With Poor Response to Cardiac Resynchronization Therapy

Optimized Left Ventricular Endocardial Stimulation Is Superior to Optimized Epicardial Stimulation in Ischemic Patients With Poor Response to Cardiac Resynchronization Therapy

Correlation of Scar in Cardiac MRI and High‐Resolution Contact Mapping of Left Ventricle in a Chronic Infarct Model

Myocardial scar imaging by standard single-energy and dual-energy late enhancement CT: Comparison with pathology and electroanatomic map in an experimental chronic infarct porcine model

Contact Info

Product

Resources

About