title: Characteristics of intramural scar in patients with nonischemic cardiomyopathy and relation to intramural ventricular arrhythmias.
abstract: BACKGROUND
  Ventricular arrhythmias have been described to originate from intramural locations. Intramural scar can be assessed by delayed-enhanced MRI, but MRIs cannot be performed on every patient. The objective of this study was to assess the value of voltage mapping to detect MRI-defined intramural scar and to correlate the scar with ventricular arrhythmias.
  
  
  RESULTS
  In 15 consecutive patients (3 women; age 55±16 years; ejection fraction, 49±13%) with structural heart disease, intramural scar was detected by delayed-enhanced MRI. All patients underwent endocardial unipolar and bipolar voltage mapping guided by the registered intramural scar. Scar volume by MRI was 11.7±8 cm3 with a scar thickness of 4.6±0.7 mm and a preserved endocardial/epicardial rim of 3.3±1.6 and 4.8±2.6 mm, respectively. Endocardial bipolar voltage was 1.6±1.73 mV at the scar, 2.12±2.15 mV in a 1 cm perimeter around the scar, and 2.83±3.39 mV in remote myocardium without scar. The corresponding unipolar voltage was 4.94±3.25, 6.59±3.81, and 8.32±3.39 mV, respectively (P<0.0001). Using receiver-operator characteristic curves, a unipolar cut-off value of 6.78 mV (area under the curve, 0.78) and a bipolar cut-off value of 1.55 mV (area under the curve, 0.69) best separated endocardial measurements overlying scar as compared with areas not overlying a scar. At least 1 intramural ventricular arrhythmia was eliminated in all but 2 patients in this series.
  
  
  CONCLUSIONS
  Intramural scar can be detected by unipolar and bipolar voltage, unipolar voltage being more useful. Mapping and ablation of intramural arrhythmias originating from an intramural focus can be accomplished.
authors.affiliation: Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI.
authors.forename: Benoit
authors.initials: B
authors.lastname: Desjardins
authors.forename: Miki
authors.initials: M
authors.lastname: Yokokawa
authors.forename: Eric
authors.initials: E
authors.lastname: Good
authors.forename: Thomas
authors.initials: T
authors.lastname: Crawford
authors.forename: Rakesh
authors.initials: R
authors.lastname: Latchamsetty
authors.forename: Krit
authors.initials: K
authors.lastname: Jongnarangsin
authors.forename: Hamid
authors.initials: H
authors.lastname: Ghanbari
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
authors.forename: Frank
authors.initials: F
authors.lastname: Bogun
mesh_terms: D001145:Arrhythmias, Cardiac / Q000503:physiopathology* / Q000601:surgery*; D055424:Cardiac-Gated Imaging Techniques; D009202:Cardiomyopathies / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation; D002921:Cicatrix / Q000473:pathology*; D003287:Contrast Media; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: ablation; magnetic resonance imaging; mapping; ventricular arrhythmia