Document Detail

Relationship Between MDCT-Imaged Myocardial Fat and Ventricular Tachycardia Substrate in Arrhythmogenic Right Ventricular Cardiomyopathy.
MedLine Citation:
PMID:  25103203     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Myocardial fibrofatty infiltration is a milieu for ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy (ARVC) and can be depicted as myocardial hypodensity on contrast-enhanced multidetector computed tomography (MDCT) with high spatial and temporal resolution. This study aimed to assess the relationship between MDCT-imaged myocardial fat and VT substrate in ARVC.
METHODS AND RESULTS: We studied 16 patients with ARVC who underwent ablation and preprocedural MDCT. High-resolution imaging data were processed and registered to high-density endocardial and epicardial maps in sinus rhythm on 3-dimensional electroanatomic mapping (3D-EAM) (626±335 and 575±279 points/map, respectively). Analysis of the locations of low-voltage and fat segmentation included the following endocardial and epicardial regions: apex, mid (anterior, lateral, inferior), and basal (anterior, lateral, inferior). The location of local abnormal ventricular activities (LAVA) was compared with fat distribution. RV myocardial fat was successfully segmented and integrated with 3D-EAM in all patients. The κ agreement test demonstrated a good concordance between the epicardial low voltage and fat (κ=0.69, 95% CI 0.54 to 0.84), but fair concordance with the endocardium (κ=0.41, 95% CI 0.27 to 0.56). The majority of LAVA (520/653 [80%]) were located within the RV fat segmentation, of which 90% were not farther than 20 mm from its border. Registration of MDCT allowed direct visualization of the coronary arteries, thus avoiding coronary damage during epicardial radiofrequency delivery.
CONCLUSIONS: The integration of MDCT-imaged myocardial fat with 3D-EAM provides valuable information on the extent and localization of VT substrate and demonstrates ablation targets clustering in its border region.
Yuki Komatsu; Amir Jadidi; Frederic Sacher; Arnaud Denis; Matthew Daly; Nicolas Derval; Ashok Shah; Heiko Lehrmann; Chan-Il Park; Reinhold Weber; Thomas Arentz; Gregor Pache; Maxime Sermesant; Nicholas Ayache; Jatin Relan; Michel Montaudon; François Laurent; Mélèze Hocini; Michel Haïssaguerre; Pierre Jaïs; Hubert Cochet
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Publication Detail:
Type:  Journal Article     Date:  2014-08-07
Journal Detail:
Title:  Journal of the American Heart Association     Volume:  3     ISSN:  2047-9980     ISO Abbreviation:  J Am Heart Assoc     Publication Date:  2014  
Date Detail:
Created Date:  2014-08-08     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101580524     Medline TA:  J Am Heart Assoc     Country:  England    
Other Details:
Languages:  eng     Pagination:  -     Citation Subset:  IM    
Copyright Information:
© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
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