Page 147 - YORAM RUDY BOOK FINAL

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Figure 5.10. (from previous page) ECGI-derived electrical scar and MRI-imaged anatomical scar.
A. Electrical scar (red) in the left anterior oblique view. The top image is based on the low-voltage
EGMs criterion only. The bottom image adds the criterion of EGM fractionation, which eliminated
the basal portion of the electrical scar. B. Representative EGMs from the scar region (red, a – f) and
from outside the scar (blue, g – i). EGMs in a, b and f are low in amplitude, whereas in c, d, and e
are also fractionated. The bottom row shows scar EGMs d, e, f together with non-scar EGMs
g, h, I on the same voltage scale to emphasize the magnitude differences. C. EGMs in c, d, and e
are shown on amplified scale to highlight fractionation. D. Comparison of electrical scar to
anatomical scar. Electrical scar (red), based on the low voltage criterion, is constructed by ECGI.
Anatomical scar is imaged with MRI (1) and annotated on the epicardial surface of the imaged
heart (2; yellow beads). Co-registration of the MRI and the ECGI CT images (3) is used to
reconstruct the anatomical scar map and to compare (4) the electrical scar (red) with the
anatomical scar (yellow). From Cuculich et. al. [281] with permission of Elsevier.

Figure 5.11. Additional images of post-MI electrical and anatomical scars. ECGI-imaged electrical
scars and MRI-imaged anatomical scars are compared. A. Apical scar. 1. (top to bottom) Sinus
rhythm activation map (AI map), EMM (electrogram magnitude map), EDM (electrogram
deflection (fractionation) map and ESM (electrical scar map, defined as a region with low voltage