Document Detail


Myocardial structural associations with local electrograms: a study of postinfarct ventricular tachycardia pathophysiology and magnetic resonance-based noninvasive mapping.
MedLine Citation:
PMID:  23149263     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The association of scar on late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) with local electrograms on electroanatomic mapping has been investigated. We aimed to quantify these associations to gain insights regarding LGE-CMR image characteristics of tissues and critical sites that support postinfarct ventricular tachycardia (VT).
METHODS AND RESULTS: LGE-CMR was performed in 23 patients with ischemic cardiomyopathy before VT ablation. Left ventricular wall thickness and postinfarct scar thickness were measured in each of 20 sectors per LGE-CMR short-axis plane. Electroanatomic mapping points were retrospectively registered to the corresponding LGE-CMR images. Multivariable regression analysis, clustered by patient, revealed significant associations among left ventricular wall thickness, postinfarct scar thickness, and intramural scar location on LGE-CMR, and local endocardial electrogram bipolar/unipolar voltage, duration, and deflections on electroanatomic mapping. Anteroposterior and septal/lateral scar localization was also associated with bipolar and unipolar voltage. Antiarrhythmic drug use was associated with electrogram duration. Critical sites of postinfarct VT were associated with >25% scar transmurality, and slow conduction sites with >40 ms stimulus-QRS time were associated with >75% scar transmurality.
CONCLUSIONS: Critical sites for maintenance of postinfarct VT are confined to areas with >25% scar transmurality. Our data provide insights into the structural substrates for delayed conduction and VT and may reduce procedural time devoted to substrate mapping, overcome limitations of invasive mapping because of sampling density, and enhance magnetic resonance-based ablation by feature extraction from complex images.
Authors:
Takeshi Sasaki; Christopher F Miller; Rozann Hansford; Juemin Yang; Brian S Caffo; Menekhem M Zviman; Charles A Henrikson; Joseph E Marine; David Spragg; Alan Cheng; Harikrishna Tandri; Sunil Sinha; Aravindan Kolandaivelu; Stefan L Zimmerman; David A Bluemke; Gordon F Tomaselli; Ronald D Berger; Hugh Calkins; Henry R Halperin; Saman Nazarian
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-11-13
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  5     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-19     Completed Date:  2013-02-26     Revised Date:  2014-01-14    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1081-90     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Catheter Ablation
Cicatrix / pathology,  surgery
Electrophysiologic Techniques, Cardiac*
Gadolinium
Humans
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Myocardial Infarction / complications*,  pathology
Myocardium / pathology*
Regression Analysis
Retrospective Studies
Tachycardia, Ventricular / physiopathology*
Grant Support
ID/Acronym/Agency:
K23 HL089333/HL/NHLBI NIH HHS; K23HL089333/HL/NHLBI NIH HHS; R01 HL094610/HL/NHLBI NIH HHS; R01-HL094610/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
AU0V1LM3JT/Gadolinium
Comments/Corrections

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