Comparing High-Density Electroanatomic Mapping and MRI: A Step Forward in Myocardial Characterization in Nonischemic...

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Sudden cardiac death (SCD) risk stratification in nonischemic cardiomyopathy (NICM) depends on identifying myocardial scars.
• Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is the standard for scar assessment.
• 3D scar maps from LGE-CMR can integrate with electroanatomic voltage mapping (EVM).

Purpose of the Study:

• To assess the concordance and reliability between LGE-CMR-derived scar maps and EVM.
• To evaluate myocardial tissue characterization using high-density catheter EVM.

Main Methods:

• A multicenter, observational study included 36 NICM patients undergoing EVM.
• LGE-CMR was performed and processed to delineate scar core and border zones.
• EVM used omnipolar technology (OT), bipolar (BIP), and unipolar (UNI) modes; Cohen's kappa and Bland-Altman methods assessed agreement and reliability.

Main Results:

• The UNI configuration showed strong agreement with subepicardial LGE-CMR maps (κ: 0.93).
• Omnipolar technology (OT) outperformed bipolar (BIP) for subendocardial layers (κ: 0.97 vs 0.74).
• OT demonstrated the least bias and narrowest limits of agreement with LGE-CMR scar maps.

Conclusions:

• EVM exhibits high agreement with LGE-CMR, accurately delineating endo-mid-myocardial substrates.
• EVM shows potential for substrate characterization in NICM patients.
• This technique is valuable for patients unsuitable for LGE-CMR.