Discordance in Scar Detection Between Electroanatomical Mapping and Cardiac MRI in an Infarct Swine Model

Selcuk Kucukseymen, Hagai Yavin, Michael Barkagan, Jihye Jang, Ayelet Shapira-Daniels, Jennifer Rodriguez, David Shim, Farhad Pashakhanloo, Patrick Pierce, Lior Botzer, Warren J. Manning, Elad Anter, Reza Nezafat*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: This study sought to investigate the sensitivity of electroanatomical mapping (EAM) to detect scar as identified by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR). Background: Previous studies have shown correlation between low voltage electrogram amplitude and myocardial scar. However, voltage amplitude is influenced by the distance between the scar and the mapping surface and its extent. The aim of this study is to examine the reliability of low voltage EAM as a surrogate for myocardial scar using LGE-derived scar as the reference. Methods: Twelve swine underwent anterior wall infarction by occlusion of the left anterior descending artery (LAD) (n = 6) or inferior wall infarction by occlusion of the left circumflex artery (LCx) (n = 6). Subsequently, animals underwent CMR and EAM using a multielectrode mapping catheter. CMR characteristics, including wall thickness, LGE location and extent, and EAM maps, were independently analyzed, and concordance between voltage maps and CMR characteristics was assessed. Results: LGE volume was similar between the LCx and LAD groups (8.5 ± 2.2 ml vs. 8.3 ± 2.5 ml, respectively; p = 0.852). LGE scarring in the LAD group was more subendocardial, affected a larger surface area, and resulted in significant wall thinning (4.88 ± 0.43 mm). LGE scarring in the LCx group extended from the endocardium to the epicardium with minimal reduction in wall thickness (scarred: 5.4 ± 0.67 mm vs. remote: 6.75 ± 0.38 mm). In all the animals in the LAD group, areas of low voltage corresponded with LGE and wall thinning, whereas only 2 of 6 animals in the LCx group had low voltage areas on EAM. Bipolar and unipolar voltage amplitudes were higher in thick inferior walls in the LCx group than in thin anterior walls in the LAD group, despite a similar LGE volume. Conclusions: Discordances between LGE-detected scar areas and low voltage areas by EAM highlighted the limitations of the current EAM system to detect scar in thick myocardial wall regions.

Original languageEnglish
Pages (from-to)1452-1464
Number of pages13
JournalJACC: Clinical Electrophysiology
Issue number11
StatePublished - 26 Oct 2020
Externally publishedYes


FundersFunder number
National Institutes of Health1R01HL127015, 1R01HL129157, 1R01HL129185-01
American Heart Association15EIA22710040, 18POST33990040
Biosense Webster
Boston Scientific Corporation


    • cardiac magnetic resonance
    • electroanatomical mapping
    • myocardial infarction model
    • wall thickness


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