Characteristic endocardial electrogram (EGM) features such as fractionation and late potentials have been associated with ventricular tachycardia (VT) substrate. Our prior analyses show that EGM frequency content allows for more accurate identification of mid-myocardial fibrosis within a given patient, compared to traditional bipolar or unipolar voltage thresholds. A relationship between frequency information and endocardial scar transmurality has not been described. To explore the relationship of frequency spectra to ventricular scar transmurality in patients undergoing VT catheter ablation. Thirteen patients with non-ischemic cardiomyopathy (NICM) undergoing VT ablation with pre-procedural tissue characterization using cardiac computed tomography (CCT) imaging with late-iodine enhancement were assessed. From the CCT data, scar transmurality was calculated for every EGM recording location. With multitaper spectral estimation, average normalized frequency content was calculated for regions with different levels of scar transmurality and compared to average frequency content from tissue locations with no scar. K-nearest neighbors classifiers were trained within patients to predict scar transmurality, assuming presence of scar is known. Frequency content of regions without scar is similar among patients. A comparison of the average normalized frequency spectra of the non-fibrotic endocardial tissue for each patient is presented. Differences in scar transmurality led to changes in strength of certain frequency bands, which varied between patients. Observed responses included a peak at 10-15 Hz whose magnitude increased with scar transmurality (panel B) and a peak at 35-40 Hz in regions with higher scar transmurality. Normalized frequency content predicted transmural scar above chance with at least p < .05 for all 13 patients. Frequency content of endocardial unipolar EGMs is related to scar transmurality in those regions. This relationship changes patient to patient, potentially due to differences in morphology of fibrotic tissue. Deviation from the consistent spectra seen in non-fibrotic tissue may be a strategy to identify fibrosis and these insights can inform development of physiological models of VT. Because of low EGM sample sizes in higher scar transmurality regions, more data should be collected to further support this claim.
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