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SHR Neuro Cancer Cardio Lipid Metab Microb
Komatsu, Y; Cochet, H; Jadidi, A; Sacher, F; Shah, A; Derval, N; Scherr, D; Pascale, P; Roten, L; Denis, A; Ramoul, K; Miyazaki, S; Daly, M; Riffaud, M; Sermesant, M; Relan, J; Ayache, N; Kim, S; Montaudon, M; Laurent, F; Hocini, M; Haïssaguerre, M; Jaïs, P.
Regional myocardial wall thinning at multidetector computed tomography correlates to arrhythmogenic substrate in postinfarction ventricular tachycardia: assessment of structural and electrical substrate.
Circ Arrhythm Electrophysiol. 2013; 6(2):342-350
Doi: 10.1161/CIRCEP.112.000191
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- Co-authors Med Uni Graz
- Scherr Daniel
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- Abstract:
- 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. 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). 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.
- Find related publications in this database (using NLM MeSH Indexing)
- Adult -
- Aged -
- Arrhythmogenic Right Ventricular Dysplasia - diagnosis
- Arrhythmogenic Right Ventricular Dysplasia - physiopathology
- Arrhythmogenic Right Ventricular Dysplasia - surgery
- Body Surface Potential Mapping -
- Catheter Ablation - methods
- Female -
- Follow-Up Studies -
- Heart Conduction System - physiopathology
- Heart Conduction System - surgery
- Heart Ventricles - diagnostic imaging
- Heart Ventricles - pathology
- Heart Ventricles - physiopathology
- Humans -
- Imaging, Three-Dimensional -
- Magnetic Resonance Imaging, Cine -
- Male -
- Middle Aged -
- Multidetector Computed Tomography - methods
- Myocardial Infarction - complications
- Myocardial Infarction - physiopathology
- Myocardium - pathology
- Reproducibility of Results -
- Retrospective Studies -
- Find related publications in this database (Keywords)
- ablation
- image integration
- multidetector computed tomography
- ventricular arrhythmia
- ventricular tachycardia