Multielectrode Unipolar Voltage Mapping and Electrogram Morphology to Identify Post-Infarct Scar Geometry: Validation by Histology

• Published in: JACC. Clinical electrophysiology Vol. 8; no. 4; pp. 437 - 449
• Main Authors: Glashan, Claire A, Tofig, Bawer J, Beukers, Hans, Tao, Qian, Blom, Sira A, Villadsen, Peter R, Lassen, Thomas R, de Riva, Marta, Kristiansen, Steen B, Zeppenfeld, Katja
• Format: Journal Article
• Language: English
• Published: United States 01-04-2022
• Subjects: Animals; Cicatrix - pathology; Endocardium - pathology; Humans; Infarction - pathology; Myocardium - pathology; Swine; Tachycardia, Ventricular - surgery; swine; substrate ablation; microelectrodes; histology; ventricular tachycardia; myocardial infarction
• ISSN: 2405-5018
• DOI: 10.1016/j.jacep.2021.11.012

This study sought to evaluate the ability of uni- and bipolar electrograms collected with a multielectrode catheter with smaller electrodes to: 1) delineate scar; and 2) determine local scar complexity.
Early reperfusion results in variable endocardial scar, often overlaid with surviving viable myocardium. Although bipolar voltage (BV) mapping is considered the pillar of substrate-based ablation, the role of unipolar voltage (UV) mapping has not been sufficiently explored. It has been suggested that bipolar electrograms collected with small electrode catheters can better identify complex scar geometries.
Twelve swine with early reperfusion infarctions were mapped with the 48-electrode OctaRay catheter and a conventional catheter during sinus rhythm. BV electrograms with double components were identified. Transmural (n = 933) biopsy specimens corresponding to mapping points were obtained, histologically assessed, and classified by scar geometry.
OctaRay UV (UV
) and BV (BV
) amplitude were associated with the amount of viable myocardium at a given location, with a stronger association for UV
(R
 = 0.767 vs 0.473). Cutoff values of 3.7 mV and 1.0 mV could delineate scar (area under the curve: 0.803 and 0.728 for UV
and BV
, respectively). The morphology of bipolar electrograms collected with the OctaRay catheter more frequently identified areas with 2 layers of surviving myocardium than electrograms collected with the conventional catheter (84% vs 71%).
UV mapping can generate a map to delineate the area of interest when using a multielectrode catheter. Within this area of interest, the morphology of bipolar electrograms can identify areas in which a surviving epicardial layer may overlay a poorly coupled, potentially arrhythmogenic, endocardium.