{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T13:36:39Z","timestamp":1793194599053,"version":"4.5.0"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Endocardial bipolar voltage amplitude is largely derived from endocardial and subendocardial wall layers. This may result in situations of low bipolar voltage amplitude despite the presence of mid-myocardial including epicardial (ie, intramural-epicardial) viable myocardium. This study examined the utility of endocardial unipolar voltage mapping for detection of viable intramural-epicardial atrial myocardium.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In 15 swine, an atrial intercaval ablation line with an intentional gap was created. Animals survived for 6 to 8 weeks before electroanatomical mapping followed by sacrifice. Gaps were determined by the presence of electrical conduction and classified based on the histopathologiclly layer(s) of viable myocardium into the following: (1) transmural, (2) endocardial, and (3) intramural-epicardial. Voltage data from healthy, scar, and gap points were exported into excel. The sensitivity and specificity of bipolar and unipolar voltage amplitude to detect intramural-epicardial gaps were compared using receiver operating characteristic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In 9 of 15 (60%) swine, a focal ablation gap was detected in the intercaval line, while in the remainder 6 of 15 (40%), the line was complete without gaps. Gaps were classified into transmural (n=3), endocardial (n=3), or intramural-epicardial (n=3). Intramural-epicardial gaps were characterized by very low bipolar voltage amplitude that was similar to areas with transmural scar (\n                      <jats:italic>P<\/jats:italic>\n                      =0.91). In comparison, unipolar voltage amplitude in intramural-epicardial gaps was significantly higher compared to transmural scar (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Unipolar voltage amplitude had higher sensitivity (93% versus 14%, respectively) and similar specificity (95% versus 98%, respectively) to bipolar voltage for detection of intramural-epicardial gaps.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Atrial unipolar voltage mapping may be a useful technique for identifying viable intramural-epicardial myocardium in patients with endocardial scar.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circep.122.011321","type":"journal-article","created":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T14:35:33Z","timestamp":1672756533000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Atrial Endocardial Unipolar Voltage Mapping for Detection of Viable Intramural Myocardium: A Proof-of-Concept Study"],"prefix":"10.1161","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0019-1102","authenticated-orcid":true,"given":"Hagai","family":"Yavin","sequence":"first","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.Y., A.Y., I.Z., K.H., E.A.), Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2485-5025","authenticated-orcid":true,"given":"Arwa","family":"Younis","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.Y., A.Y., I.Z., K.H., E.A.), Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6663-2348","authenticated-orcid":true,"given":"Israel","family":"Zilberman","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.Y., A.Y., I.Z., K.H., E.A.), Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9316-866X","authenticated-orcid":true,"given":"Alison","family":"Krywanczyk","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine (A.K.), Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5698-4091","authenticated-orcid":true,"given":"Zachary P.","family":"Bubar","sequence":"additional","affiliation":[{"name":"Biosense Webster of Johnson &amp; Johnson, Irvine, CA (Z.P.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9218-1966","authenticated-orcid":true,"given":"Koji","family":"Higuchi","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.Y., A.Y., I.Z., K.H., E.A.), Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7553-7214","authenticated-orcid":true,"given":"Michael","family":"Barkagan","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Shamir Medical Center, Be\u2019er Ya\u2019akov, Israel (M.B., E.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8199-2288","authenticated-orcid":true,"given":"Elad","family":"Anter","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.Y., A.Y., I.Z., K.H., E.A.), Cleveland Clinic, OH."},{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Shamir Medical Center, Be\u2019er Ya\u2019akov, Israel (M.B., E.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.91.9.2385"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.115.003648"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2019.02.018"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.09.033"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.110.959957"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2010.09.088"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.08.977"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000215"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/pace.13298"}],"container-title":["Circulation: Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.122.011321","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T21:21:36Z","timestamp":1715548896000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.122.011321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1161\/CIRCEP.122.011321"],"URL":"https:\/\/doi.org\/10.1161\/circep.122.011321","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]},"assertion":[{"value":"2022-06-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}