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. 2024 Apr;10(4):637-650.
doi: 10.1016/j.jacep.2023.12.003. Epub 2024 Jan 24.

Multisize Electrode Field-of-View: Validation by High Resolution Gadolinium-Enhanced Cardiac Magnetic Resonance

Sharif Omara  1 , Claire A Glashan  1 , Bawer J Tofig  2 , Lore Leenknegt  3 , Hans Dierckx  3 , Alexander V Panfilov  4 , Hans K C Beukers  5 , Michiel H van Waasbergen  5 , Qian Tao  6 , William G Stevenson  7 , Jens C Nielsen  2 , Peter Lukac  2 , Steen B Kristiansen  2 , Rob J van der Geest  8 , Katja Zeppenfeld  9
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Free article

Multisize Electrode Field-of-View: Validation by High Resolution Gadolinium-Enhanced Cardiac Magnetic Resonance

Sharif Omara et al. JACC Clin Electrophysiol. 2024 Apr.
Free article

Abstract

Background: Voltage mapping to detect ventricular scar is important for guiding catheter ablation, but the field-of-view of unipolar, bipolar, conventional, and microelectrodes as it relates to the extent of viable myocardium (VM) is not well defined.

Objectives: The purpose of this study was to evaluate electroanatomic voltage-mapping (EAVM) with different-size electrodes for identifying VM, validated against high-resolution ex-vivo cardiac magnetic resonance (HR-LGE-CMR).

Methods: A total of 9 swine with early-reperfusion myocardial infarction were mapped with the QDOT microcatheter. HR-LGE-CMR (0.3-mm slices) were merged with EAVM. At each EAVM point, the underlying VM in multisize transmural cylinders and spheres was quantified from ex vivo CMR and related to unipolar and bipolar voltages recorded from conventional and microelectrodes.

Results: In each swine, 220 mapping points (Q1, Q3: 216, 260 mapping points) were collected. Infarcts were heterogeneous and nontransmural. Unipolar and bipolar voltage increased with VM volumes from >175 mm3 up to >525 mm3 (equivalent to a 5-mm radius cylinder with height >6.69 mm). VM volumes in subendocardial cylinders with 1- or 3-mm depth correlated poorly with all voltages. Unipolar voltages recorded with conventional and microelectrodes were similar (difference 0.17 ± 2.66 mV) and correlated best to VM within a sphere of radius 10 and 8 mm, respectively. Distance-weighting did not improve the correlation.

Conclusions: Voltage increases with transmural volume of VM but correlates poorly with small amounts of VM, which limits EAVM in defining heterogeneous scar. Microelectrodes cannot distinguish thin from thick areas of subendocardial VM. The field-of-view for unipolar recordings for microelectrodes and conventional electrodes appears to be 8 to 10 mm, respectively, and unexpectedly similar.

Keywords: late-gadolinium enhancement; microelectrodes; non-transmural scar; voltage mapping.

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Conflict of interest statement

Funding Support and Author Disclosures This study was partially supported by an investigator-initiated grant from Biosense Webster (a Johnson and Johnson company). Dr Tofig has received research support from the Arvid Nilssons Foundation. Mr Leenknegt was funded by FWO-Flanders grant number G025820N and KU Leuven grant STG/19/007. Outside this work, Dr Nielsen has received research support from the Novo Nordisk Foundation (grants NNF16OC0018658 and NNF17OC0029148). Dr Lukac has received an institutional grant from Abbott Denmark and Biosense Webster. All other authors have reported that they have no relationships to disclose that are relevant to the contents of this paper.

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