on October 7, 2008
Published online before print October 7, 2008, doi: 10.1161/CIRCEP.108.799619
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Original Article |
A Comparison of Electroanatomic Contact and Noncontact Mapping of Ventricular Scar in a Post Infarct Ovine Model With Intramural Needle Electrode Recording and Histological Validation
Cardiology Department, Westmead Hospital, Sydney, Australia
1 E-mail: tsgopal{at}hotmail.com
Background—Substrate based ablation is useful for non-haemodynamically tolerated post infarct ventricular tachycardia. We assessed the accuracy of the CARTO contact and EnSite noncontact systems at identifying scar in a chronic ovine model with intramural plunge needle electrode recording and histological validation.
Methods and Results—Scar mapping was performed on 8 male sheep with previous percutaneous - induced myocardial infarction. Up to 20 plunge needles were inserted into the left ventricle of each animal in areas of dense scar, scar border, and normal myocardium. A simultaneous CARTO map and EnSite geometry were acquired using a single catheter, and needle electrode locations were registered. A Dynamic Substrate Map (DSM) was constructed using ratiometric 50% Peak Negative Voltage. The scar percentage around each needle location was quantified histologically. Analysis was performed on 152 plunge needles and corresponding histological blocks. Spearman's Correlation with histology was 0.690 (p<0.001) for needle electrode peak-to-peak voltage (PPV), 0.362 (p<0.001) and 0.492 (p<0.001) for CARTO bipolar and unipolar PPV, and 0.381 (p<0.001) for EnSite DSM (
40mm from array). The area under the Receiver Operator Characteristics curve (<50% and 
50% scar) was 0.896 for needle electrode PPV, 0.726 and 0.697 for CARTO bipolar and unipolar PPV, and 0.703 for EnSite DSM (40mm from array).
Conclusions—Both the CARTO contact and EnSite noncontact systems were moderately accurate in identifying post infarct scar when compared with intramural electrodes and confirmed with histology. The EnSite DSM was comparable to the CARTO contact bipolar PPV when points >40mm from the array were excluded.
Key Words: arrhythmia • electrophysiology • mapping • myocardial infarction
Related Article
Circ Arrhythm Electrophysiol 2008 1: 363-369.
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