Three‐dimensional myocardial scar characterization from the endocardium: Usefulness of endocardial unipolar electroanatomic mapping. (12th January 2019)

• Record Type: Journal Article
• Authors: Bazan, Victor; Frankel, David S.; Santangeli, Pasquale; Garcia, Fermin C.; Tschabrunn, Cory M.; Marchlinski, Francis E.
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 30:Number 3(2019)
• Page Start: 427
• Page End: 437
• Publication Date: 2019-01-12
• Subjects: cardiomyopathy -- electroanatomic mapping -- unipolar electrogram -- ventricular tachycardia; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.13842
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: 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.