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Detailed comparison between the wall thickness and voltages in chronic myocardial infarction

2018; Wiley; Volume: 30; Issue: 2 Linguagem: Inglês

10.1111/jce.13767

1540-8167

Masateru Takigawa, Ruairidh Martin, Ghassen Cheniti, Τakeshi Kitamura, Konstantinos Vlachos, Antonio Frontera, Claire Martin, Félix Bourier, Anna Lam, Xavier Pillois, Josselin Duchâteau, Nicolas Klotz, Thomas Pambrun, Arnaud Denis, Nicolas Derval, Mélèze Hocini, Michel Haı̈ssaguerre, Frédéric Sacher, Pierre Jaı̈s, Hubert Cochet,

Cardiac pacing and defibrillation studies

Abstract 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.