Electrophysiologic Scar Substrate in Relation to VT: Noninvasive High‐Resolution Mapping and Risk Assessment with ECGI

• DOI: 10.1111/pace.12882
• Publication Date: 2016-05-21T13:09:17Z
• Authors: JUNJIE ZHANG; DANIEL H. COOPER; KAVIT A. DESOUZA; PHILLIP S. CUCULICH; PAMELA K. WOODARD; TIMOTHY W. SMITH; YORAM RUDY
• Keywords: Ischemic Cardiomyopathy; Reentry

Ischemic cardiomyopathy (ICM) can provide the substrate for ventricular tachycardia (VT).To map noninvasively with high resolution electrophysiologic (EP) scar substrate, identify its relationship to reentry circuits during VT, and stratify VT risk in ICM patients.Noninvasive high-resolution epicardial mapping electrocardiographic imaging (ECGI) was performed 32 patients (17 clinical 15 without VT). Abnormal EP determined based on electrogram (EGM) amplitude (as percentage of maximal peak-to-peak voltage over entire epicardium; total [TS] < 30%; dense [DS] 15%), fractionation, presence late potentials (LPs). Scar burden defined as ratio size surface area. The activation pattern mapped correlated components circuit.Patients had higher (TS: 51.0 ± 9.3% vs 36.5 5.4%, P 0.05; DS: 29.5 7.3% 16.8 6.8%, 0.05) lower normalized unipolar EGM 0.107 0.027 0.153 0.031, 0.073 0.023 0.098 0.026, 0.05), greater prevalence fractionated EGMs 44.1 10.6% 26.8 6.3%, 50.8 10.8% 30.9 7.0%, LPs 10.7% 15.8 5.3, 0.05). VTs were eight patients; closely related substrate.ECGI identified that underlies abnormal conduction patients. It regions within aligned critical elements circuit VT. ECGI potentially be used stratification