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Directional Influences of Ventricular Activation on
Myocardial Scar Characterization
by Roderick Tung, Mark E. Josephson, Jason S. Bradfield, and Kalyanam Shivkumar
Circ Arrhythm Electrophysiol
Volume 9(8):e004155
August 11, 2016
Copyright © American Heart Association, Inc. All rights reserved.
Calculation of concordance in low-voltage detection by overlap percentage between 2 maps with
different activation wavefronts in a patient with postinfarct anterior scar.
Roderick Tung et al. Circ Arrhythm Electrophysiol.
2016;9:e004155
Copyright © American Heart Association, Inc. All rights reserved.
Direct electrogram verification of a discordant region of low voltage detected in sinus rhythm
with right bundle branch block pattern (<1.5 mV) but not during right ventricular (RV) pacing
(>1.5 mV) in a patient with ischemic cardiomyopathy (ICM).
Roderick Tung et al. Circ Arrhythm Electrophysiol.
2016;9:e004155
Copyright © American Heart Association, Inc. All rights reserved.
Histogram of low-voltage areas (bipolar <1.5 [A] and unipolar <8.3 mV [B]) across all patients
mapped from left ventricular (LV) endocardium with different ventricular activation wavefronts.
Roderick Tung et al. Circ Arrhythm Electrophysiol.
2016;9:e004155
Copyright © American Heart Association, Inc. All rights reserved.
Significant discordance with septal scar in a patient with nonischemic cardiomyopathy (NICM)
detected during right ventricular (RV) pacing which is not seen during left ventricular (LV)
pacing.
Roderick Tung et al. Circ Arrhythm Electrophysiol.
2016;9:e004155
Copyright © American Heart Association, Inc. All rights reserved.
Example of an ischemic cardiomyopathy (ICM) patient with minimal concordant bipolar
abnormalities on inferoseptal left ventricle (LV) during both sinus rhythm and right ventricular
(RV) pacing with discordant regions of low unipolar voltage in the apex (RAO caudal view) and
lateral wall (left lateral view).
Roderick Tung et al. Circ Arrhythm Electrophysiol.
2016;9:e004155
Copyright © American Heart Association, Inc. All rights reserved.
Degree of concordance between areas of scar detected during multiple activation wavefronts in
all 29 patients expressed as overlap percentage (black bar).
Roderick Tung et al. Circ Arrhythm Electrophysiol.
2016;9:e004155
Copyright © American Heart Association, Inc. All rights reserved.
Discordant scar area detected in a ischemic cardiomyopathy (ICM) patient with basal lateral scar
where a larger region of low voltage was seen during left ventricular (LV) pacing compared with
right ventricular (RV) pacing.
Roderick Tung et al. Circ Arrhythm Electrophysiol.
2016;9:e004155
Copyright © American Heart Association, Inc. All rights reserved.
A critical presystolic site for a targeted ventricular tachycardia (VT) was identified within patchy
nonischemic cardiomyopathy (NICM) septal scar during left ventricular (LV) pacing but was
within normal tissue during right ventricular (RV) pacing.
Roderick Tung et al. Circ Arrhythm Electrophysiol.
2016;9:e004155
Copyright © American Heart Association, Inc. All rights reserved.