New Adjusted Cutoffs for "Normal" Endocardial Voltages in Patients With Post-Infarct LV Remodeling
Language English Country United States Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
31648735
DOI
10.1016/j.jacep.2019.07.007
PII: S2405-500X(19)30504-3
Knihovny.cz E-resources
- Keywords
- electroanatomic mapping, endocardial voltage, fibrosis, scar, ventricular remodeling,
- MeSH
- Electrophysiologic Techniques, Cardiac * MeSH
- Endocardium diagnostic imaging physiology physiopathology MeSH
- Myocardial Infarction complications physiopathology MeSH
- Cicatrix diagnostic imaging etiology physiopathology MeSH
- Catheter Ablation MeSH
- Tachycardia, Ventricular etiology physiopathology surgery MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging, Cine MeSH
- Magnetic Resonance Imaging MeSH
- Reference Values MeSH
- Ventricular Remodeling physiology MeSH
- Aged MeSH
- Case-Control Studies MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
OBJECTIVES: This study sought to determine new reference cutoffs for normal unipolar voltage (UV) and bipolar voltage (BV) that would be adjusted for the LV remodeling. BACKGROUND: The definition of "normal" left ventricular (LV) endocardial voltage in patients with post-infarct scar is still lacking. The reference voltage of the noninfarcted myocardium (NIM) may differ between patients depending on LV structural remodeling and the ensuing interstitial fibrosis. METHODS: Electroanatomic voltage mapping was integrated with isotropic late gadolinium-enhanced cardiac magnetic resonance in 15 patients with nonremodeled LV and 12 patients with remodeled LV (end-systolic volume index >50 ml/m2 with ejection fraction <47% assessed by cardiac magnetic resonance). Reference voltages (fifth percentile values) were determined from pooled NIM segments without late gadolinium enhancement. RESULTS: The cutoffs for normal BV and UV were ≥3.0 and ≥6.7 mV for nonremodeled LV and ≥2.1 and ≥6.4 mV for remodeled LV. Endocardial low-voltage area (LVA) defined by the adjusted cutoffs corresponded better to late gadolinium enhancement-detected scar than did LVA defined by uniform cutoffs. In 15 patients who underwent successful ablation of ventricular tachycardia, the LVA contained >97% of targeted evoked delayed potentials. Insights from whole-heart T1 mapping revealed more fibrotic NIM in patients with remodeled LV compared with nonremodeled LV. CONCLUSIONS: This study found substantial differences in endocardial voltage of NIM in post-infarct patients with remodeled versus nonremodeled LV. The new adjusted cutoffs for "normal" BV and UV enable a patient-tailored approach to electroanatomic voltage mapping of LV.
Department of Cardiology Leiden University Medical Center Leiden the Netherlands
Department of Radiology Leiden University Medical Center Leiden the Netherlands
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