Author + information
- Received December 18, 2007
- Revision received April 22, 2008
- Accepted May 20, 2008
- Published online September 2, 2008.
- Andrei Codreanu, MD⁎,§,
- Freddy Odille, MS§,
- Etienne Aliot, MD⁎,
- Pierre-Yves Marie, MD, PhD†∥,
- Isabelle Magnin-Poull, MD⁎,
- Marius Andronache, MD⁎,
- Damien Mandry, MD‡,
- Wassila Djaballah, MD†,§,
- Denis Régent, MD‡,§,
- Jacques Felblinger, PhD§ and
- Christian de Chillou, MD, PhD⁎,§,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Christian de Chillou, Département de Cardiologie - CHU de Nancy, 54511 Vandoeuvre les Nancy Cedex, France
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 (<6.52 and <1.54 mV, respectively), as well as a longer bipolar EGM duration (>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.
- myocardial infarction
- ventricular tachycardia
- magnetic resonance imaging
- catheter ablation
- Received December 18, 2007.
- Revision received April 22, 2008.
- Accepted May 20, 2008.
- American College of Cardiology Foundation