Electroanatomical voltage and morphology characteristics in postinfarction patients undergoing ventricular tachycardia ablation: pragmatic approach favoring late potentials abolition

Circ Arrhythm Electrophysiol. 2015 Aug;8(4):863-73. doi: 10.1161/CIRCEP.114.002551. Epub 2015 May 28.


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.

Methods and 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.

Keywords: catheter ablation; endocardium; myocardial infarction; myocardium; tachycardia; ventricular.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Body Surface Potential Mapping / methods*
  • Catheter Ablation*
  • Coronary Angiography
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Tachycardia, Ventricular / diagnosis
  • Tachycardia, Ventricular / physiopathology*
  • Tachycardia, Ventricular / surgery