TY - JOUR
T1 - Epicardial Conduction Speed, Electrogram Abnormality, and Computed Tomography Attenuation Associations in Arrhythmogenic Right Ventricular Cardiomyopathy
AU - Ustunkaya, Tuna
AU - Desjardins, Benoit
AU - Wedan, Riley
AU - Chahal, C. Anwar A.
AU - Zimmerman, Stefan L.
AU - Saju, Nissi
AU - Zahid, Sohail
AU - Sharma, Apurva
AU - Han, Yuchi
AU - Trayanova, Natalia
AU - Marchlinski, Francis E.
AU - Calkins, Hugh
AU - Tandri, Harikrishna
AU - Nazarian, Saman
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/10
Y1 - 2019/10
N2 - Objectives: This study sought to evaluate the association between contrast-enhanced multidetector computed tomography (CE-MDCT) attenuation and local epicardial conduction speed (ECS) and electrographic abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and ventricular tachycardia (VT). Background: CE-MDCT is a widely available and fast imaging technology with high spatial resolution that is less prone to defibrillator generator−related safety issues and image artifacts. However, the association between hypoattenuation on MDCT and VT substrates in ARVC remains unknown. Methods: Patients with ARVC who underwent CE-MDCT followed by endocardial (n = 30) and epicardial (n = 21) electroanatomical mapping (EAM) and VT ablation were prospectively enrolled. Right ventricular (RV) mid-myocardial attenuation was calculated from 3-dimensional MDCT images and registered to EAM. Local ECS was calculated by averaging the ECS between each point and 5 adjacent points with concordant wave front direction. Results: A total of 17,311 epicardial and 5,204 endocardial points were included. In multivariable regression analysis clustered by patient, RV myocardial attenuation was associated with epicardial bipolar voltage amplitude (2.5% decrease in amplitude per 10 HU decrease in attenuation; p < 0.001), with endocardial unipolar voltage amplitude (0.9% decrease in amplitude per 10 HU decrease in attenuation; p < 0.001), and with ECS (0.4% decrease in ECS per 10 HU decrease in attenuation; p = 0.001). Conclusions: CE-MDCT attenuation distribution is associated with regional ECS and electrographic amplitude in ARVC. Regions with low attenuation likely reflect fibro-fatty involvement in the RV and may serve as important VT substrates in patients with ARVC who are undergoing VT ablation.
AB - Objectives: This study sought to evaluate the association between contrast-enhanced multidetector computed tomography (CE-MDCT) attenuation and local epicardial conduction speed (ECS) and electrographic abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and ventricular tachycardia (VT). Background: CE-MDCT is a widely available and fast imaging technology with high spatial resolution that is less prone to defibrillator generator−related safety issues and image artifacts. However, the association between hypoattenuation on MDCT and VT substrates in ARVC remains unknown. Methods: Patients with ARVC who underwent CE-MDCT followed by endocardial (n = 30) and epicardial (n = 21) electroanatomical mapping (EAM) and VT ablation were prospectively enrolled. Right ventricular (RV) mid-myocardial attenuation was calculated from 3-dimensional MDCT images and registered to EAM. Local ECS was calculated by averaging the ECS between each point and 5 adjacent points with concordant wave front direction. Results: A total of 17,311 epicardial and 5,204 endocardial points were included. In multivariable regression analysis clustered by patient, RV myocardial attenuation was associated with epicardial bipolar voltage amplitude (2.5% decrease in amplitude per 10 HU decrease in attenuation; p < 0.001), with endocardial unipolar voltage amplitude (0.9% decrease in amplitude per 10 HU decrease in attenuation; p < 0.001), and with ECS (0.4% decrease in ECS per 10 HU decrease in attenuation; p = 0.001). Conclusions: CE-MDCT attenuation distribution is associated with regional ECS and electrographic amplitude in ARVC. Regions with low attenuation likely reflect fibro-fatty involvement in the RV and may serve as important VT substrates in patients with ARVC who are undergoing VT ablation.
KW - arrhythmogenic right ventricular cardiomyopathy
KW - conduction speed
KW - endocardial mapping
KW - epicardial mapping
KW - multidetector computed tomography
KW - ventricular tachycardia ablation
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U2 - 10.1016/j.jacep.2019.06.017
DO - 10.1016/j.jacep.2019.06.017
M3 - Article
C2 - 31648740
AN - SCOPUS:85073102193
SN - 2405-500X
VL - 5
SP - 1158
EP - 1167
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 10
ER -