Area weighted unipolar voltage to predict heart failure death in patients with ischemic cardiomyopathy and ventricular tachycardia. (19th May 2022)

• Record Type: Journal Article
• Authors: Rademaker, R; Kimura, Y; Beukers, HC; Piers, SR; Wijnmaalen, AP; De Riva Silva, M; Dekkers, OM; Zeppenfeld, K
• Is Part Of: Europace. Volume 24:Supplement 1(2022)
• Publication Date: 2022-05-19
• Subjects: Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac053.361
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: None. Background: Patients with ischemic cardiomyopathy (ICM) referred for catheter ablation (CA) of ventricular tachycardia (VT) are at risk for end-stage heart failure (HF) due to adverse remodeling of the left ventricle (LV). Local unipolar voltages (UV) decrease with loss of viable myocardium. A UV mapping derived parameter that corrects for oversampling of the infarct area may reflect the total amount of remaining LV viable myocardium. Objective: To evaluate if the newly proposed parameter, `area weighted unipolar voltage' (awUV), can predict HF related death/LVAD/Heart transplant (HFD) in ICM. Methods: Voltage maps from consecutive patients with ICM referred for CA of VT, were transferred to Paraview after valve area removal. AwUV was calculated by mathematically interpolating all mapping points weighted for relative distances divided by the LV endocardial surface. Unipolar low voltage areas (ULVA, UV<8.27mV) were measured as percentage of the total LV surface. Associations between clinical and mapping derived parameters and HFD (HF-related death/LVAD/heart transplant) were evaluated and validated in a second cohort of consecutive patients. Results: Eighty-nine patients in the study group (age 68±8; LVEF 33% [IQR 24-40%]; ULVA 64% [IQR 46-86%]; awUV 7.01 [IQR 5.01-8.52]) and 69 patients in the validation group (age 68±9; LVEF 39% [IQR 29-44%]; ULVA 59% [IQR 43-77%]; awUV 7.60 [IQR 6.16-8.69]) were included. Follow-up was 32±17 months in the study group, 28±17 months in the validation group. HFD was 20% in the study group, 10% in the validation cohort. Patients with HFD had lower LVEF and awUV, and larger ULVA than patients without HFD (LVEF 23±10% vs. 35±11%; awUV: 5.12±1.92 vs. 7.75±2.64; LVA 86±21% vs. 60±23%, all P<0.001). Univariable analysis showed that LVEF, ULVA and awUV were associated with HFD (HR and 95% CI: LVEF 1.10 [1.05 – 1.16]; LVA 1.05 [1.02 – 1.08]; awUV 2.18 [1.58 – 3.40], all P<0.01). AwUV was superior to ULVA to predict HFD in likelihood ratio calculations (awUV: LR 5.66, P=0.02; LVA: 1.76 P=0.18) and ROC analysis (AUC awUV: 0.86; LVA 0.78). The optimal cut-off for awUV of<5.27 was highly accurate to predict HFD in the validation cohort (log-rank P<0.001). Conclusion: The newly proposed parameter awUV, easily available from routine voltage mapping, may be useful at identifying ICM patients at risk for HFD.