TY - JOUR
T1 - Association of regional myocardial conduction velocity with the distribution of hypoattenuation on contrast-enhanced perfusion computed tomography in patients with postinfarct ventricular tachycardia
AU - Ustunkaya, Tuna
AU - Desjardins, Benoit
AU - Liu, Bolun
AU - Zahid, Sohail
AU - Park, Jaeseok
AU - Saju, Nissi
AU - Trayanova, Natalia
AU - Zimmerman, Stefan L.
AU - Marchlinski, Francis E.
AU - Nazarian, Saman
N1 - Publisher Copyright:
© 2018 Heart Rhythm Society
PY - 2019/4
Y1 - 2019/4
N2 - Background: Cardiac magnetic resonance imaging has been shown to be beneficial for identification of the ventricular tachycardia (VT) substrate before catheter ablation. Contrast-enhanced perfusion multidetector computed tomography (CEP-MDCT) is more generalizable to clinical practice, and wall thickness and regional hypoenhancement on CEP-MDCT can identify potential substrate sites, albeit with decreased specificity. Objective: The purpose of this study was to evaluate the association between wall thickness and attenuation on CEP-MDCT with local conduction velocity (CV) and electrogram abnormalities in patients with postinfarct VT. Methods: Fourteen patients with postinfarct VT underwent preprocedural CEP-MDCT followed by endocardial electroanatomic mapping (EAM) and ablation. Myocardial attenuation and wall thickness were calculated from 3-dimensional MDCT images using ADAS-VT software (Galgo Medical). EAM was registered with 3-dimensional MDCT images using the CartoMERGE module of CARTO3 software (Biosense Webster). Local CV was calculated by averaging the velocity between each point and 5 adjacent points with concordant wavefront direction. Results: A total of 3689 points were included. In multivariable regression analysis clustered by patient, local CV was positively associated with myocardial attenuation, bipolar voltage, unipolar voltage, and wall thickness. Each 10-HU drop in full-thickness attenuation correlated to 2.6% decrease in CV (P <.001) and 5.5% decrease in bipolar voltage amplitude (P <.001), after adjusting for wall thickness. Conclusion: Myocardial attenuation distribution on CEP-MDCT is associated with regional CV and electrogram amplitude. Regions with low CV identified with low attenuation on CEP-MDCT may serve as important VT substrates in postinfarct patients.
AB - Background: Cardiac magnetic resonance imaging has been shown to be beneficial for identification of the ventricular tachycardia (VT) substrate before catheter ablation. Contrast-enhanced perfusion multidetector computed tomography (CEP-MDCT) is more generalizable to clinical practice, and wall thickness and regional hypoenhancement on CEP-MDCT can identify potential substrate sites, albeit with decreased specificity. Objective: The purpose of this study was to evaluate the association between wall thickness and attenuation on CEP-MDCT with local conduction velocity (CV) and electrogram abnormalities in patients with postinfarct VT. Methods: Fourteen patients with postinfarct VT underwent preprocedural CEP-MDCT followed by endocardial electroanatomic mapping (EAM) and ablation. Myocardial attenuation and wall thickness were calculated from 3-dimensional MDCT images using ADAS-VT software (Galgo Medical). EAM was registered with 3-dimensional MDCT images using the CartoMERGE module of CARTO3 software (Biosense Webster). Local CV was calculated by averaging the velocity between each point and 5 adjacent points with concordant wavefront direction. Results: A total of 3689 points were included. In multivariable regression analysis clustered by patient, local CV was positively associated with myocardial attenuation, bipolar voltage, unipolar voltage, and wall thickness. Each 10-HU drop in full-thickness attenuation correlated to 2.6% decrease in CV (P <.001) and 5.5% decrease in bipolar voltage amplitude (P <.001), after adjusting for wall thickness. Conclusion: Myocardial attenuation distribution on CEP-MDCT is associated with regional CV and electrogram amplitude. Regions with low CV identified with low attenuation on CEP-MDCT may serve as important VT substrates in postinfarct patients.
KW - Catheter ablation
KW - Conduction velocity
KW - Contrast-enhanced computed tomography
KW - Hypoattenuation
KW - Ischemic cardiomyopathy
KW - Ventricular tachycardia
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U2 - 10.1016/j.hrthm.2018.10.029
DO - 10.1016/j.hrthm.2018.10.029
M3 - Article
C2 - 30935494
AN - SCOPUS:85059350329
SN - 1547-5271
VL - 16
SP - 588
EP - 594
JO - Heart Rhythm
JF - Heart Rhythm
IS - 4
ER -