High-density substrate mapping of the left ventricle as a guide for endomyocardial biopsy: an omnipolar, bipolar, and cardiac magnetic resonance imaging perspective

• Published in: Europace (London, England) England), 2022-05, Vol.24 (Supplement_1)
• Main Authors: Casella, M, Compagnucci, P, Volpato, G, La Piscopia, V, Bondavalli, B, Valeri, Y, Cipolletta, L, Parisi, Q, Molini, S, Misiani, A, Messano, L, Ricciotti, J, Guerra, F, Dello Russo, A
• Format: Article
• Language: English
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euac053.045

Abstract Funding Acknowledgements Type of funding sources: None. Background The recent introduction of Omnipolar Technology (OT) has the potential to improve ventricular substrate characterization. In fact, the amplitude of omnipolar electrograms is less dependent of the propagation direction of the recorded wavefront than that of bipolar electrograms, potentially increasing the sensitivity for the detection of viable myocardium by electroanatomical voltage mapping (EVM). Purpose To assess the presence and extension of dense scar regions and low-voltage areas in omnipolar voltage (OV) maps of the left ventricle (LV) as compared to standard bipolar endocardial maps and cardiac magnetic resonance (CMR)-derived pixel signal intensity (PSI) maps, among patients undergoing EVM-guided endomyocardial biopsy (EMB). Methods The study included 10 patients undergoing LV substrate mapping and EVM-guided EMB at our institution using the Advisor HD Grid mapping catheter. Before the procedure, contrast enhanced-CMR was obtained for each patient and PSI maps were derived from late gadolinium enhancement sequences with the ADAS-VT software. Scar core and border zone areas were measured in PSI endocardial (10-40% of wall thickness) maps and compared to dense scar regions (