Value of noncontact mapping for identifying left ventricular scar in an ovine model.
BACKGROUND
We assessed the hypothesis that "virtual electrograms" from a noncontact mapping system (EnSite 3000) could be used to localize myocardial scar.


RESULTS
Myocardial infarctions were induced in sheep by inflating an angioplasty balloon in the left anterior descending coronary artery for 3 hours. Scar mapping was performed on 8 sheep without inducible ventricular tachycardia by use of the noncontact mapping system and a 256-channel contact mapping system. Transmural mapping needles were inserted into myocardial regions that were (1) scarred, (2) peripheral to the scar, and (3) distant from the scar. Unipolar electrograms were exported from both systems and analyzed on a personal computer workstation. The percentage of myocardial scarring at each needle site was assessed histologically. Pearson's correlation was used to assess the degree of association between various electrogram characteristics and the presence of myocardial scarring. The only noncontact electrogram characteristic that showed any association with the presence of myocardial scarring was the negative slope duration (contact, r=0.62, P<0.001; noncontact, r=0.23, P=0.004). The other electrogram characteristics studied were electrogram maximal deflection (contact, r=0.38, P<0.001; noncontact, r=0.03, P=0.75) and minimal slope (contact, r=0.42, P<0.001; noncontact, r=0.05, P=0.54).


CONCLUSIONS
Noncontact electrograms do not reliably identify ventricular scar. Alternative strategies such as importing computed tomography images into the geometry should be used when scar localization is important.
Thiagalingam
Aravinda
A
Cardiology Department, Westmead Hospital, Westmead, Sydney, Australia.
Wallace
Elisabeth M
EM
Campbell
Craig R
CR
Boyd
Anita C
AC
Eipper
Vicki E
VE
Byth
Karen
K
Ross
David L
DL
Kovoor
Pramesh
P
D000818:Animals; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D002304:Cardiac Pacing, Artificial; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002921:Cicatrix / Q000209:etiology / Q000473:pathology*; D004594:Electrophysiology / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D006352:Heart Ventricles / Q000473:pathology*; D021621:Imaging, Three-Dimensional; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology*; D012756:Sheep; D014584:User-Computer Interface