Scar conducting channel characterization to predict arrhythmogenicity during ventricular tachycardia ablation. Issue 3 (4th January 2023)

• Record Type: Journal Article
• Authors: Sanchez-Somonte, Paula; Garre, Paz; Vázquez-Calvo, Sara; Quinto, Levio; Borràs, Roger; Prat, Susanna; Ortiz-Perez, Jose T; Steghöfer, Martin; Figueras i Ventura, Rosa M; Guasch, Eduard; Tolosana, José Maria; Arbelo, Elena; Brugada, Josep; Sitges, Marta; Mont, Lluís; Roca-Luque, Ivo
• Is Part Of: Europace. Volume 25:Issue 3(2023)
• Page Start: 989
• Page End: 999
• Publication Date: 2023-01-04
• Subjects: Ventricular tachycardia -- cardiac magnetic resonance -- scar -- heterogeneous tissue channel -- conducting channel; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac257
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Heterogeneous tissue channels (HTCs) detected by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) are related to ventricular arrhythmias, but there are few published data about their arrhythmogenic characteristics. Methods and results: We enrolled 34 consecutive patients with ischaemic and non-ischaemic cardiomyopathy who were referred for ventricular tachycardia (VT) ablation. LGE-CMR was performed prior to ablation, and the HTCs were analyzed. Arrhythmogenic HTCs linked to induced VT were identified during the VT ablation procedure. The characteristics of arrhythmogenic HTCs were compared with those of non-arrhythmogenic HTCs. Three patients were excluded due to low-quality LGE-CMR images. A total of 87 HTCs were identified on LGE-CMR in 31 patients (age:63.8 ± 12.3 years; 96.8% male; left ventricular ejection fraction: 36.1 ± 10.7%). Of the 87 HTCs, only 31 were considered arrhythmogenic because of their relation to a VT isthmus. The HTCs related to a VT isthmus were longer [64.6 ± 49.4 vs. 32.9 ± 26.6 mm; OR: 1.02; 95% CI: (1.01–1.04); P < 0.001] and had greater mass [2.5 ± 2.2 vs. 1.2 ± 1.2 grams; OR: 1.62; 95% CI: (1.18–2.21); P < 0.001], a higher degree of protectedness [26.19 ± 19.2 vs. 10.74 ± 8.4; OR 1.09; 95% CI: (1.04–1.14); P < 0.001], higher transmurality [number of wall layers with CCs: 3.8 ± 2.4 vs. 2.4 ± 2.0; OR: 1.31; 95% CI: (1.07–1.60); P = 0.008] and more ramifications [3.8 ± 2.0 vs. 2.7 ± 1.1; OR: 1.59; 95% CI: (1.15–2.19); P = 0.002] than non-arrhythmogenic HTCs. Multivariate logistic regression analysis revealed that protectedness was the strongest predictor of arrhythmogenicity. Conclusion: The protectedness of an HTC identified by LGE-CMR is strongly related to its arrhythmogenicity during VT ablation. Graphical Abstract: Graphical Abstract