Contact-force monitoring increases accuracy of right ventricular voltage mapping avoiding “false scar” detection in patients with no evidence of structural heart disease

摘要

PURPOSE:Electroanatomical mapping (EAM) could increase cardiac magnetic resonance imaging (CMR) sensitivity in detecting ventricular scar. Possible bias may be scar over-estimation due to inadequate tissue contact. Aim of the study is to evaluate contact-force monitoring influence during EAM, in patients with idiopathic right ventricular arrhythmias.METHODS:20?pts (13?M; 43?±?12?y) with idiopathic right ventricular outflow tract (RVOT) arrhythmias and no structural abnormalities were submitted to Smarttouch catheter Carto3 EAM. Native maps included points collected without considering contact-force. EAM scar was defined as area ≥1 cm 2 including at least 3 adjacent points with signal amplitude (bipolar 0.5?mV, unipolar 3,5?mV), surrounded by low-voltage border zone. EAM were re-evaluated offline, removing points collected with contact force 5?g. Finally, contact force-corrected maps were compared to the native ones.RESULTS:An EAM was created for each patient (345?±?85 points). After removing poor contact points, a mean of 149?±?60 points was collected. The percentage of false scar, collected during contact force blinded mapping compared to total volume, was 6.0?±?5.2% for bipolar scar and 7.1?±?5.9% for unipolar scar, respectively. No EAM scar was present after poor contact points removal. Right ventricular areas analysis revealed a greater number of points with contact force 5?g acquired in free wall, where reduced mean bipolar and unipolar voltage were recorded.CONCLUSIONS:To date this is the first work conducted on structurally normal hearts in which contact-force significantly increases EAM accuracy, avoiding "false scar" related to non-adequate contact between catheter and tissue.Copyright ? 2020 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.