Whole human heart histology to validate electroanatomical voltage mapping in patients with non-ischaemic cardiomyopathy and ventricular tachycardia

Glashan, Claire A.; Androulakis, Afa; Tao, Qian; Glashan, Ross N; Wisse, Lambertus J.; Ebert, Micaela; Ruiter, Marijke; Meer, Berend J. van; Brouwer, Charlotte L.; Dekkers, Olaf M.; Pijnappels, Daniël A.; Bakker, Jacques M.T. de; Riva, Marta; Piers, Sebastiaan R.D.; Zeppenfeld, Katja

doi:10.1093/eurheartj/ehy168

Cited by 126 publications

(96 citation statements)

References 36 publications

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“…Nevertheless, significant overlap in voltage amplitudes between scar and normal myocardium and substantial inter-patient differences [3][4][5] limit the validity of distinct voltage cut-off values to identify scar. 6 These data suggest that additional factors may affect the voltage amplitudes. 7 Substantial differences in characterization of scar by low-voltage areas between intrinsic rhythm and ventricular pacing were recently reported, 8 indicating that the activation sequence influences voltage amplitudes.…”

Section: Introductionmentioning

confidence: 90%

A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: anin vivoandin silicostudy

et al. 2018

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Aims he aim of this study was to investigate the influence of the activation sequence on voltage amplitudes by evaluating regional voltage differences during a left bundle branch block (LBBB) activation sequence vs. a normal synchronous activation sequence and by evaluating pacing-induced voltage differences. Methods and results wenty-one patients and three computer models without scar were studied. Regional voltage amplitudes were evaluated in nine LBBB patients who underwent endocardial electro-anatomic mapping (EAM). Pacing-induced voltage differences were evaluated in 12 patients who underwent epicardial EAM during intrinsic rhythm and right ventricular (RV) pacing. Three computer models customized for LBBB patients were created. Changes in voltage amplitudes after an LBBB (intrinsic), a normal synchronous, an RV pacing, and a left ventricular pacing activation sequence were assessed in the computer models. Unipolar voltage amplitudes in patients were approximately 4.5 mV (4.4-4.7 mV, 33%) lower in the septum when compared with other segments. A normal synchronous activation sequence in the computer models normalized voltage amplitudes in the septum. Pacinginduced differences were larger in electrograms with higher voltage amplitudes during intrinsic rhythm and furthermore larger and more variable at the epicardium [mean absolute difference: 3.6-6.2 mV, 40-53% of intrinsic value; interquartile range (IQR) differences: 53-63% of intrinsic value] compared to the endocardium (mean absolute difference: 3.3-3.8 mV, 28-30% of intrinsic value; IQR differences: 37-40% of intrinsic value). Conclusion In patients and computer models without scar, lower septal unipolar voltage amplitudes are exclusively associated with an LBBB activation sequence. Pacing substantially affects voltage amplitudes, particularly at the epicardium.

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Section: Introductionmentioning

confidence: 90%

A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: anin vivoandin silicostudy

et al. 2018

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“…As will be discussed, additional work has prospectively validated the use of the less than 8.3 mV UNIP voltage cutoff in the LV as a reference to define a high likelihood of diseased intramural and epi myocardium and guide VT ablation procedures, to predict an unfavorable clinical outcome of the nonischemic cardiomyopathy (NICM) and ICM and to identify irreversibility of PVC-induced LV cardiomyopathy. 20,[28][29][30][31][32][33][34] A similar methodology based on determination of the fifth percentile of the distribution of UNIP voltage values in normal individuals was used for the right ventricle (RV) free wall, with a less than 5.5 mV reference F I G U R E 2 Influence of high-pass filtering on unipolar electrogram configuration. Bipolar (Bi 1-2) and unipolar (Uni) recordings are registered from electrodes 1 to 2 during ventricular tachycardia mapping.…”

Section: Defining Normal Unip Voltage Valuesmentioning

confidence: 99%

“…A greater wall thickness as such occurs when LV hypertrophy increases the cutoff value for "normal" endo UNIP voltage. 17,29 On the basis of our experience, in the presence of LV wall thickening (hypertrophic/ hypertensive cardiomyopathies) and/or regional increments in the wall thickness as noted in some other NICMs, we recommend increasing the endo UNIP voltage reference for defining normal by adjusting the voltage slider bar in 0.5 mV increments up to 10 or 11 mV and determining if a single area of lower voltage can be identified suggesting scar at a distance from the endo ( Figure 6).…”

Section: Endocardial Unip Signals To Identify Abnormal Bp Voltage Imentioning

confidence: 99%

Three‐dimensional myocardial scar characterization from the endocardium: Usefulness of endocardial unipolar electroanatomic mapping

Bazán

Frankel

García

et al. 2019

Cardiovasc electrophysiol

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Epicardial ablation may be required to eliminate ventricular tachycardia (VT) in patients with underlying structural heart disease. The decision to gain epicardial access is frequently based on the suspicion of an epicardial origin for the VT and/or presence of an arrhythmogenic substrate. Epicardial pathology and VT is frequently present in patients with nonischemic right and/or left cardiomyopathies even in the setting of modest or no endocardial bipolar voltage substrate. In this setting, unipolar voltage mapping from the endocardium serves to help identify midmyocardial and/or epicardial VT substrate. The additional value of endocardial unipolar mapping includes its usefulness to predict the clinical outcome after VT ablation, to determine the irreversibility of myocardial disease, and to guide endomyocardial biopsy procedures to specific areas of intramural scarring. In this review, we aim to provide a guide to the use of endocardial unipolar mapping and its appropriate interpretation in a variety of clinical situations.

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“…Both fibrosis density and type played a role in the possibility of generating a reentry in our model NIDCM geometry. This is significant because detailed quantification of the absolute type and level of fibrosis in LGE images in NIDCM patients is currently not possible, due to the lack of comparison between core scar and remote tissue, as is commonly used in assessing infarct fibrotic density in patients with ischemic cardiomyopathy [7].…”

Section: Discussionmentioning

confidence: 99%

The Effects of Non-ischemic Fibrosis Texture and Density on Mechanisms of Reentry

Balaban

Halliday

Costa

et al. 2018

2018 Computing in Cardiology Conference (CinC)

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Patients who present with non-ischemic dilated cardiomyopathy and enhancement on late gadolinium magnetic resonance imaging (LGE-CMR), are at high risk of sudden cardiac death. Further risk stratification of these patients based on LGE-CMR may be improved through better understanding of fibrosis micro-structure. Our aim is to examine variations in fibrosis micro-structure based on LGE imaging, and quantify the effect on reentry inducibility. 2D Computational models were created from a single short axis LGE-CMR image, with variations in fibrosis type (interstitial, replacement) and density. For each fibrosis-type density combination 10 different models were created, each representing a separate random realization. In total 200 models were tested. Reentry inducibility showed a dependence on fibrosis type and density as well as on the specific random realization of the type-density combination.

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Whole human heart histology to validate electroanatomical voltage mapping in patients with non-ischaemic cardiomyopathy and ventricular tachycardia

Cited by 126 publications

References 36 publications

A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: anin vivoandin silicostudy

A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: anin vivoandin silicostudy

Three‐dimensional myocardial scar characterization from the endocardium: Usefulness of endocardial unipolar electroanatomic mapping

The Effects of Non-ischemic Fibrosis Texture and Density on Mechanisms of Reentry

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