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CLINICAL RESEARCH: CARDIAC IMAGING

Electroanatomic Characterization of Post-Infarct Scars

Comparison With 3-Dimensional Myocardial Scar Reconstruction Based on Magnetic Resonance Imaging

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^_*,,_*

^_* Department of Cardiology, University Hospital Nancy, Nancy, France
Department of Nuclear Medicine, University Hospital Nancy, Nancy, France
Department of Radiology, University Hospital Nancy, Nancy, France
IADI INSERM ERI 13, University Hospital Nancy, Nancy, France
^|| UHP-INSERM 684, Medicine School, Nancy, France

Manuscript received December 18, 2007; revised manuscript received April 22, 2008, accepted May 20, 2008.

^_* Reprint requests and correspondence: Dr. Christian de Chillou, Département de Cardiologie - CHU de Nancy, 54511 Vandoeuvre les Nancy Cedex, France (Email: c.dechillou{at}chu-nancy.fr).

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.

Key Words: myocardial infarction • ventricular tachycardia • magnetic resonance imaging • electrophysiology • catheter ablation

Abbreviations and Acronyms   DCE = delayed contrast enhancement   EAM = electroanatomic mapping   ECG = electrocardiogram   EGM = electrogram   LV = left ventricle   MRI = magnetic resonance imaging   ROC = receiver-operator curve   3D = 3-dimensional   VT = ventricular tachycardia

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