Unipolar peak-negative voltage as an endocardial electrographic characteristic to predict overlying abnormal epicardial substrates in patients with right epicardial ventricular tachycardia

Po Ching Chi, Yenn Jiang Lin, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Tze Fan Chao, Fa Po Chung, Jonan Liao, Ta Chuan Tuan, Jen Yuan Kuo, Jin Long Huang, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Endocardial Unipolar Peak-Negative Voltage Predicts Abnormal Epicardial Substrates Introduction The characteristics of endocardial electrograms needed to detect the overlying abnormal epicardial substrates in arrhythmogenic right ventricular cardiomyopathy with epicardial ventricular tachycardia (VT) remain unclear. This study investigated which of the endocardial electrogram characteristics could predict the overlying abnormal epicardial substrates. Methods and Results In 20 consecutive patients (median age: 46 years, 11 men) undergoing epicardial VT ablation, detailed endocardial and epicardial mappings were obtained by using the CARTO 3 system. The endocardial electrographic characteristics (unipolar peak-to-peak voltage, unipolar peak-negative-voltage, bipolar voltage, and bipolar electrogram duration) of the opposite endocardium and epicardium in RV were retrospectively investigated (N = 1,697 paired points, 84 ± 60 pairs/patient). Endocardial predictors of the presence of epicardial dense scar (<0.5 mV), low voltage zones (LVZ; ≤1.5 mV), and ablation targets (by using activation mapping, entrainment mapping, and pace mapping) were analyzed. Results In the multivariable analysis, (1) unipolar peak-negative voltage independently predicted the presence of epicardial LVZ, epicardial dense scar, and ablation targets; (2) bipolar voltage could not predict epicardial lesions; and (3) bipolar electrogram duration predicted epicardial LVZ, but not dense scar or ablation targets. The endocardial unipolar peak-negative voltage of <1.66 mV (89% sensitivity and 53% specificity) was the optimal cutoff point for predicting epicardial dense scar. Conclusions In patients with RV epicardial VT, the presence of unipolar peak-negative voltage of <1.66 mV in the endocardium predicted the presence of epicardial dense scar (<0.5 mV) and potential ablation targets in the overlying epicardium.

Original languageEnglish
Pages (from-to)1343-1349
Number of pages7
JournalJournal of cardiovascular electrophysiology
Volume25
Issue number12
DOIs
StatePublished - 1 Dec 2014

Keywords

  • arrhythmogenic right ventricular cardiomyopathy
  • catheter ablation
  • endocardial unipolar electrocardiogram
  • epicardial low voltage zone
  • epicardial scar
  • ventricular tachycardia

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