title: Electroanatomical voltage and morphology characteristics in postinfarction patients undergoing ventricular tachycardia ablation: pragmatic approach favoring late potentials abolition.
abstract: BACKGROUND
  Catheter ablation is an important therapeutic option in postmyocardial infarction patients with ventricular tachycardia (VT). We analyzed the endo-epicardial electroanatomical mapping (EAM) voltage and morphology characteristics, their association with clinical data and their prognostic value in a large cohort of postmyocardial infarction patients.
  
  
  RESULTS
  We performed total and segmental analysis of voltage (bipolar dense scar [DS] and low voltage areas, unipolar low voltage and penumbra areas) and morphology characteristics (presence of abnormal late potentials [LPs] and early potentials [EPs]) in 100 postmyocardial infarction patients undergoing electroanatomical mapping-based VT ablation (26 endo-epicardial procedures) from 2010-2012. All patients had unipolar low voltage areas, whereas 18% had no identifiable endocardial bipolar DS areas. Endocardial bipolar DS area >22.5 cm(2) best predicted scar transmurality. Endo-epicardial LPs were recorded in 2/3 patients, more frequently in nonseptal myocardial segments and were abolished in 51%. Endocardial bipolar DS area >7 cm(2) and endocardial bipolar scar density >0.35 predicted epicardial LPs. Isolated LPs are located mainly epicardially and EPs endocardially. As a primary strategy, LPs and VT-mapping ablation occurred in 48%, only VT-mapping ablation in 27%, only LPs ablation in 17%, and EPs ablation in 6%. Endocardial LP abolition was associated with reduced VT recurrence and increased unipolar penumbra area predicted cardiac death.
  
  
  CONCLUSIONS
  Endocardial scar extension and density predict scar transmurality and endo-epicardial presence of LPs, although DS is not always identified in postmyocardial infarction patients. LPs, most frequently located in nonseptal myocardial segments, were abolished in 51% resulting in improved outcome.
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tsiachris
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: John
authors.initials: J
authors.lastname: Silberbauer
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maccabelli
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Oloriz
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Baratto
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Mizuno
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Bisceglia
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Vergara
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marzi
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Nicoleta
authors.initials: N
authors.lastname: Sora
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Guarracini
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Radinovic
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Cireddu
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Sala
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Gulletta
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Paglino
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Mazzone
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Trevisi
authors.affiliation: From the Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy. dellabella.paolo@hsr.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Della Bella
mesh_terms: D000368:Aged; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery
keywords: catheter ablation; endocardium; myocardial infarction; myocardium; tachycardia; ventricular