Premium
Detailed comparison between the wall thickness and voltages in chronic myocardial infarction
Author(s) -
Takigawa Masateru,
Martin Ruairidh,
Cheniti Ghassen,
Kitamura Takeshi,
Vlachos Konstantinos,
Frontera Antonio,
Martin Claire A.,
Bourier Felix,
Lam Anna,
Pillois Xavier,
Duchateau Josselin,
Klotz Nicolas,
Pambrun Thomas,
Denis Arnaud,
Derval Nicolas,
Hocini Mélèze,
Haïssaguerre Michel,
Sacher Frédéric,
Jaïs Pierre,
Cochet Hubert
Publication year - 2019
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13767
Subject(s) - medicine , ventricular tachycardia , voltage , myocardial infarction , significant difference , infarction , nuclear medicine , cardiology , electrical engineering , engineering
Background The relationship between the local electrograms (EGMs) and wall thickness (WT) heterogeneity within infarct scars has not been thoroughly described. The relationship between WT and voltages and substrates for ventricular tachycardia (VT) was examined. Methods In 12 consecutive patients with myocardial infarction and VT, WT, defined by a multidetector computed tomography, and voltage were compared. In multicomponent EGMs, amplitudes of both far‐ and near‐field components were manually measured, and the performance of the three‐dimensional‐mapping system automatic voltage measurement was assessed. Results Of 15 748 points acquired, 2677 points within 5 mm of the endocardial surface were analyzed. In total, 909 (34.0%) multicomponent EGMs were identified; 785 (86.4%) and 883 (97.1%) were distributed in the WT less than 4 and 5 mm, respectively. Far‐field EGM voltages increased linearly from 0.14 mV (0.08‐0.28 mV) in the WT: 0 to 1 mm to 0.70 mV (0.43‐2.62 mV) in the WT: 4 to 5 mm (ρ = 0.430; P < 0.001), and a significant difference was demonstrated between any two WT‐groups ( P ≤ 0.001). In contrast, near‐field EGM voltages varied from 0.27 mV (0.11‐0.44 mV) in the WT: 0 to 1 mm to 0.29 mV (0.17‐0.53 mV) in the WT: 4 to 5 mm with a poorer correlation (ρ = 0.062, P = 0.04). The proportion of points where the system automatically measured the voltage on near‐field EGMs increased from less than 10% in areas of WT: 4 to 5 mm to 50% in areas less than 2 mm. Of 21 VTs observed, seven hemodynamically stable VTs were mapped and terminated in WT: 1 to 4 mm area. Conclusions Although far‐field voltages gradually increase with the WT, near‐field does not. The three‐dimensional–mapping system preferentially annotates the near‐field components in thinner areas (center of the scar) and the far‐field component in thicker areas when building a voltage map. Critical sites of VT are distributed in WT: 1 to 4 mm areas.