Regional myocardial wall thinning at multidetector computed tomography correlates to arrhythmogenic substrate in postinfarction ventricular tachycardia: assessment of structural and electrical substrate

Komatsu, Yuki; Cochet, Hubert; Jadidi, Amir; Sacher, Frédéric; Shah, Ashok; Derval, Nicolas; Scherr, Daniel; Pascale, Patrizio; Roten, Laurent; Denis, Arnaud; Ramoul, Khaled; Miyazaki, Shinsuke; Daly, Matthew; Riffaud, Matthieu; Sermesant, Maxime; Relan, Jatin; Ayache, Nicholas; Kim, Steven; Montaudon, Michel; Laurent, François; ... (2013). Regional myocardial wall thinning at multidetector computed tomography correlates to arrhythmogenic substrate in postinfarction ventricular tachycardia: assessment of structural and electrical substrate. Circulation - arrhythmia and electrophysiology, 6(2), pp. 342-50. Lippincott Williams & Wilkins 10.1161/CIRCEP.112.000191

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BACKGROUND

A majority of patients undergoing ablation of ventricular tachycardia have implanted devices precluding substrate imaging with delayed-enhancement MRI. Contrast-enhanced multidetector computed tomography (MDCT) can depict myocardial wall thickness with submillimetric resolution. We evaluated the relationship between regional myocardial wall thinning (WT) imaged by MDCT and arrhythmogenic substrate in postinfarction ventricular tachycardia.

METHODS AND RESULTS

We studied 13 consecutive postinfarction patients undergoing MDCT before ablation. MDCT data were integrated with high-density 3-dimensional electroanatomic maps acquired during sinus rhythm (endocardium, 509±291 points/map; epicardium, 716±323 points/map). Low-voltage areas (<1.5 mV) and local abnormal ventricular activities (LAVA) during sinus rhythm were assessed with regard to the WT. A significant correlation was found between the areas of WT <5 mm and endocardial low voltage (correlation-R=0.82; P=0.001), but no such correlation was found in the epicardium. The WT <5 mm area was smaller than the endocardial low-voltage area (54 cm(2) [Q1-Q3, 46-92] versus 71 cm(2) [Q1-Q3, 59-124]; P=0.001). Among a total of 13 060 electrograms reviewed in the whole study population, 538 LAVA were detected and analyzed. LAVA were located within the WT <5 mm (469/538 [87%]) or at its border (100% within 23 mm). Very late LAVA (>100 ms after QRS complex) were almost exclusively detected within the thinnest area (93% in the WT<3 mm).

CONCLUSIONS

Regional myocardial WT correlates to low-voltage regions and distribution of LAVA critical for the generation and maintenance of postinfarction ventricular tachycardia. The integration of MDCT WT with 3-dimensional electroanatomic maps can help focus mapping and ablation on the culprit regions, even when MRI is precluded by the presence of implanted devices.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Roten, Laurent

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1941-3149

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Laurent Roten

Date Deposited:

26 Feb 2014 10:18

Last Modified:

13 Jul 2015 14:43

Publisher DOI:

10.1161/CIRCEP.112.000191

PubMed ID:

23476043

URI:

https://boris.unibe.ch/id/eprint/42251

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