Impact of Spacing and Orientation on the Scar Threshold With a High-Density Grid Catheter
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Published:2019-09
Issue:9
Volume:12
Page:
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ISSN:1941-3149
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Container-title:Circulation: Arrhythmia and Electrophysiology
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language:en
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Short-container-title:Circ: Arrhythmia and Electrophysiology
Author:
Takigawa Masateru12, Relan Jatin13, Kitamura Takeshi1, Martin Claire A.14, Kim Steven13, Martin Ruairidh15, Cheniti Ghassen1, Vlachos Konstantinos1, Massoullié Grégoire1, Frontera Antonio1, Thompson Nathaniel1, Wolf Michael1, Bourier Felix1, Lam Anna1, Duchateau Josselin1, Pambrun Thomas1, Denis Arnaud1, Derval Nicolas1, Pillois Xavier1, Magat Julie1, Naulin Jerome1, Merle Mathilde1, Collot Florent1, Quesson Bruno1, Cochet Hubert1, Hocini Mélèze1, Haïssaguerre Michel1, Sacher Frederic1, Jaïs Pierre1
Affiliation:
1. IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac–Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.). 2. Heart Rhythm Center, Tokyo Medical and Dental University, Japan (M.T.). 3. Abbott, Minneapolis, MN (J.R., S.K.). 4. Royal Papworth Hospital, Cambridge (C.A.M.). 5. Institute of Genetic Medicine, Newcastle University, United Kingdom (R.M.).
Abstract
Background:
Multipolar catheters are increasingly used for high-density mapping. However, the threshold to define scar areas has not been well described for each configuration. We sought to elucidate the impact of bipolar spacing and orientation on the optimal threshold to match magnetic resonance imaging-defined scar.
Method:
The HD-Grid catheter uniquely allows for different spatially stable bipolar configurations to be tested. We analyzed the electrograms with settings of HD-16 (3 mm spacing in both along and across bipoles) and HD-32 (1 mm spacing in along bipoles and 3 mm spacing in across bipoles) and determined the optimal cutoff for scar detection in 6 infarcted sheep.
Results:
From 456 total acquisition sites (mean 76±12 per case), 14 750 points with the HD-16 and 32286 points with the HD-32 configuration for bipolar electrograms were analyzed. For bipolar voltages, the optimal cutoff value to detect the magnetic resonance imaging-defined scar based on the Youden’s Index, and the area under the receiver operating characteristic curve (AUROC) differed depending on the spacing and orientation of bipoles; across 0.84 mV (AUROC, 0.920; 95% CI, 0.911–0.928), along 0.76 mV (AUROC, 0.903; 95% CI, 0.893–0.912), north-east direction 0.95 mV (AUROC, 0.923; 95% CI, 0.913–0.932), and south-east direction, 0.87 mV (AUROC, 0.906; 95% CI, 0.895–0.917) in HD-16; and across 0.83 mV (AUROC, 0.917; 95% CI, 0.911–0.924), along 0.46 mV (AUROC, 0.890; 95% CI, 0.883–0.897), north-east direction 0.89 mV (AUROC, 0.923; 95% CI, 0.917–0.929), and south-east direction 0.83 mV (AUROC, 0.913; 95% CI, 0.906–0.920) in HD-32. Significant differences in AUROC were seen between HD-16 along versus across (
P
=0.002), HD-16 north-east direction versus south-east direction (
P
=0.01), HD-32 north-east direction versus south-east direction (
P
<0.0001), and HD-16 along versus HD-32 along (
P
=0.006). The AUROC was significantly larger (
P
<0.01) when only the best points on each given site were selected for analysis, compared with when all points were used.
Conclusions:
Spacing and orientation of bipoles impacts the accuracy of scar detection. Optimal threshold specific to each bipolar configuration should be determined. Selecting one best voltage point among multiple points projected on the same surface is also critical on the Ensite-system to increase the accuracy of scar-mapping.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
21 articles.
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