Unipolar Peak-Negative Voltage as an Endocardial Electrographic Characteristic to Predict Overlying Abnormal Epicardial Substrates in Patients with Right Epicardial Ventricular Tachycardia

Endocardial Unipolar Peak-Negative Voltage Predicts Abnormal Epicardial Substrates. Introduction: The characteristics of endocardial electrograms needed to detect the overlying abnormal epicardial substrates in arrhythmogenic right ventricular cardiomyopathy with epicardial ventricular tachycardia (VT) remain unclear. This study investigated which of the endocardial electrogram characteristics could predict the overlying abnormal epicardial substrates. Methods and Results: In 20 consecutive patients (median age: 46 years, 11 men) undergoing epicardial VT ablation, detailed endocardial and epicardial mappings were obtained by using the CARTO 3 system. The endocardial electrographic characteristics (unipolar peak-to-peak voltage, unipolar peak-negative-voltage, bipolar voltage, and bipolar electrogram duration) of the opposite endocardium and epicardium in RV were retrospectively investigated (N = 1,697 paired points, 84 +/- 60 pairs/patient). Endocardial predictors of the presence of epicardial dense scar (<0.5 mV), low voltage zones (LVZ; <= 1.5 mV), and ablation targets (by using activation mapping, entrainment mapping, and pace mapping) were analyzed. Results: In the multivariable analysis, (1) unipolar peak-negative voltage independently predicted the presence of epicardial LVZ, epicardial dense scar, and ablation targets; (2) bipolar voltage could not predict epicardial lesions; and (3) bipolar electrogram duration predicted epicardial LVZ, but not dense scar or ablation targets. The endocardial unipolar peak-negative voltage of <1.66 mV (89% sensitivity and 53% specificity) was the optimal cutoff point for predicting epicardial dense scar. Conclusions: In patients with RV epicardial VT, the presence of unipolar peak-negative voltage of <1.66 mV in the endocardium predicted the presence of epicardial dense scar (<0.5 mV) and potential ablation targets in the overlying epicardium.