Epicardial Conduction Speed, Electrogram Abnormality, and Computed Tomography Attenuation Associations in Arrhythmogenic Right Ventricular Cardiomyopathy

Tuna Ustunkaya, Benoit Desjardins, Riley Wedan, C. Anwar A. Chahal, Stefan L. Zimmerman, Nissi Saju, Sohail Zahid, Apurva Sharma, Yuchi Han, Natalia Trayanova, Francis E. Marchlinski, Hugh Calkins, Harikrishna Tandri, Saman Nazarian

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1158-1167
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume5
Issue number10
DOIs
StatePublished - Oct 2019

Keywords

  • arrhythmogenic right ventricular cardiomyopathy
  • conduction speed
  • endocardial mapping
  • epicardial mapping
  • multidetector computed tomography
  • ventricular tachycardia ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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  • Cite this

    Ustunkaya, T., Desjardins, B., Wedan, R., Chahal, C. A. A., Zimmerman, S. L., Saju, N., Zahid, S., Sharma, A., Han, Y., Trayanova, N., Marchlinski, F. E., Calkins, H., Tandri, H., & Nazarian, S. (2019). Epicardial Conduction Speed, Electrogram Abnormality, and Computed Tomography Attenuation Associations in Arrhythmogenic Right Ventricular Cardiomyopathy. JACC: Clinical Electrophysiology, 5(10), 1158-1167. https://doi.org/10.1016/j.jacep.2019.06.017