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 - Funding Information:
Dr. Nazarian is supported by the National Institutes of Health (NIH) (grants R01HL116280 and R01HL142893). Dr. Trayanova is supported by NIH (grant PD1HL123271) and a grant from the Foundation Leducq. Dr. Zimmerman has been an advisor for Siemens Healthcare. Dr. Nazarian has been a consultant for St. Jude Medical, Siemens, Biosense Webster, and CardioSolv; and has received research funding from Biosense Webster, Imricor, and Siemens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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 - 2405-5018
VL - 5
SP - 1158
EP - 1167
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 10
ER -