Unipolar Endocardial Voltage Mapping in the Right Ventricle: Optimal Cutoff Values Correcting for Computed Tomography-Derived Epicardial Fat Thickness and Their Clinical Value for Substrate Delineation.

Autor:	Venlet J; From the Departments of Cardiology (J.V., S.R.D.P., G.F.L.K., M.d.R., P.F.G.P., K.Z.) and Image Processing (R.J.v.d.G.), Leiden University Medical Center, The Netherlands., Piers SRD; From the Departments of Cardiology (J.V., S.R.D.P., G.F.L.K., M.d.R., P.F.G.P., K.Z.) and Image Processing (R.J.v.d.G.), Leiden University Medical Center, The Netherlands., Kapel GFL; From the Departments of Cardiology (J.V., S.R.D.P., G.F.L.K., M.d.R., P.F.G.P., K.Z.) and Image Processing (R.J.v.d.G.), Leiden University Medical Center, The Netherlands., de Riva M; From the Departments of Cardiology (J.V., S.R.D.P., G.F.L.K., M.d.R., P.F.G.P., K.Z.) and Image Processing (R.J.v.d.G.), Leiden University Medical Center, The Netherlands., Pauli PFG; From the Departments of Cardiology (J.V., S.R.D.P., G.F.L.K., M.d.R., P.F.G.P., K.Z.) and Image Processing (R.J.v.d.G.), Leiden University Medical Center, The Netherlands., van der Geest RJ; From the Departments of Cardiology (J.V., S.R.D.P., G.F.L.K., M.d.R., P.F.G.P., K.Z.) and Image Processing (R.J.v.d.G.), Leiden University Medical Center, The Netherlands., Zeppenfeld K; From the Departments of Cardiology (J.V., S.R.D.P., G.F.L.K., M.d.R., P.F.G.P., K.Z.) and Image Processing (R.J.v.d.G.), Leiden University Medical Center, The Netherlands. K.Zeppenfeld@lumc.nl.
Jazyk:	angličtina
Zdroj:	Circulation. Arrhythmia and electrophysiology [Circ Arrhythm Electrophysiol] 2017 Aug; Vol. 10 (8).
DOI:	10.1161/CIRCEP.117.005175
Abstrakt:	Background: Low endocardial unipolar voltage (UV) at sites with normal bipolar voltage (BV) may indicate epicardial scar. Currently applied UV cutoff values are based on studies that lacked epicardial fat information. This study aimed to define endocardial UV cutoff values using computed tomography-derived fat information and to analyze their clinical value for right ventricular substrate delineation. Methods and Results: Thirty-three patients (50±14 years; 79% men) underwent combined endocardial-epicardial right ventricular electroanatomical mapping and ablation of right ventricular scar-related ventricular tachycardia with computed tomographic image integration, including computed tomography-derived fat thickness. Of 6889 endocardial-epicardial mapping point pairs, 547 (8%) pairs with distance <10 mm and fat thickness <1.0 mm were analyzed for voltage and abnormal (fragmented/late potential) electrogram characteristics. At sites with endocardial BV >1.50 mV, the optimal endocardial UV cutoff for identification of epicardial BV <1.50 mV was 3.9 mV (area under the curve, 0.75; sensitivity, 60%; specificity, 79%) and cutoff for identification of abnormal epicardial electrogram was 3.7 mV (area under the curve, 0.88; sensitivity, 100%; specificity, 67%). The majority of abnormal electrograms (130 of 151) were associated with transmural scar. Eighty-six percent of abnormal epicardial electrograms had corresponding endocardial sites with BV <1.50 mV, and the remaining could be identified by corresponding low endocardial UV <3.7 mV. Conclusions: For identification of epicardial right ventricular scar, an endocardial UV cutoff value of 3.9 mV is more accurate than previously reported cutoff values. Although the majority of epicardial abnormal electrograms are associated with transmural scar with low endocardial BV, the additional use of endocardial UV at normal BV sites improves the diagnostic accuracy resulting in identification of all epicardial abnormal electrograms at sites with <1.0 mm fat. (© 2017 American Heart Association, Inc.)
Databáze:	MEDLINE
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