Marek Sramko1, Saif Abdel-Kafi2, Rob J van der Geest3, Marta de Riva2, Claire A Glashan2, Hildo J Lamb3, Katja Zeppenfeld4. 1. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 2. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. 3. Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. 4. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: k.zeppenfeld@lumc.nl.
Abstract
OBJECTIVES: This study sought to determine new reference cutoffs for normal unipolar voltage (UV) and bipolar voltage (BV) that would be adjusted for the LV remodeling. BACKGROUND: The definition of "normal" left ventricular (LV) endocardial voltage in patients with post-infarct scar is still lacking. The reference voltage of the noninfarcted myocardium (NIM) may differ between patients depending on LV structural remodeling and the ensuing interstitial fibrosis. METHODS: Electroanatomic voltage mapping was integrated with isotropic late gadolinium-enhanced cardiac magnetic resonance in 15 patients with nonremodeled LV and 12 patients with remodeled LV (end-systolic volume index >50 ml/m2 with ejection fraction <47% assessed by cardiac magnetic resonance). Reference voltages (fifth percentile values) were determined from pooled NIM segments without late gadolinium enhancement. RESULTS: The cutoffs for normal BV and UV were ≥3.0 and ≥6.7 mV for nonremodeled LV and ≥2.1 and ≥6.4 mV for remodeled LV. Endocardial low-voltage area (LVA) defined by the adjusted cutoffs corresponded better to late gadolinium enhancement-detected scar than did LVA defined by uniform cutoffs. In 15 patients who underwent successful ablation of ventricular tachycardia, the LVA contained >97% of targeted evoked delayed potentials. Insights from whole-heart T1 mapping revealed more fibrotic NIM in patients with remodeled LV compared with nonremodeled LV. CONCLUSIONS: This study found substantial differences in endocardial voltage of NIM in post-infarct patients with remodeled versus nonremodeled LV. The new adjusted cutoffs for "normal" BV and UV enable a patient-tailored approach to electroanatomic voltage mapping of LV.
OBJECTIVES: This study sought to determine new reference cutoffs for normal unipolar voltage (UV) and bipolar voltage (BV) that would be adjusted for the LV remodeling. BACKGROUND: The definition of "normal" left ventricular (LV) endocardial voltage in patients with post-infarct scar is still lacking. The reference voltage of the noninfarcted myocardium (NIM) may differ between patients depending on LV structural remodeling and the ensuing interstitial fibrosis. METHODS: Electroanatomic voltage mapping was integrated with isotropic late gadolinium-enhanced cardiac magnetic resonance in 15 patients with nonremodeled LV and 12 patients with remodeled LV (end-systolic volume index >50 ml/m2 with ejection fraction <47% assessed by cardiac magnetic resonance). Reference voltages (fifth percentile values) were determined from pooled NIM segments without late gadolinium enhancement. RESULTS: The cutoffs for normal BV and UV were ≥3.0 and ≥6.7 mV for nonremodeled LV and ≥2.1 and ≥6.4 mV for remodeled LV. Endocardial low-voltage area (LVA) defined by the adjusted cutoffs corresponded better to late gadolinium enhancement-detected scar than did LVA defined by uniform cutoffs. In 15 patients who underwent successful ablation of ventricular tachycardia, the LVA contained >97% of targeted evoked delayed potentials. Insights from whole-heart T1 mapping revealed more fibrotic NIM in patients with remodeled LV compared with nonremodeled LV. CONCLUSIONS: This study found substantial differences in endocardial voltage of NIM in post-infarctpatients with remodeled versus nonremodeled LV. The new adjusted cutoffs for "normal" BV and UV enable a patient-tailored approach to electroanatomic voltage mapping of LV.
Authors: Radosław Kurzelowski; Kamil Barański; Guido Caluori; Wojciech Szot; Krzysztof Grabowski; Aleksandra Michalewska-Włudarczyk; Marcin Syzdół; Wacław Kuczmik; Anna Błach; Beata Ochała; Damian Hudziak; Jacek Wilczek; Krzysztof S Gołba; Zdenek Starek; Michał Tendera; Wojciech Wojakowski; Tomasz Jadczyk Journal: Postepy Kardiol Interwencyjnej Date: 2021-09-14 Impact factor: 1.426
Authors: Raquel Adeliño; Daina Martínez-Falguera; Carolina Curiel; Albert Teis; Roger Marsal; Oriol Rodríguez-Leor; Cristina Prat-Vidal; Edgar Fadeuilhe; Júlia Aranyó; Elena Revuelta-López; Axel Sarrias; Víctor Bazan; Joan F Andrés-Cordón; Santiago Roura; Roger Villuendas; Josep Lupón; Antoni Bayes-Genis; Carolina Gálvez-Montón; Felipe Bisbal Journal: Front Cardiovasc Med Date: 2022-09-20