Regional myocardial wall thinning at multidetector computed tomography correlates to arrhythmogenic substrate in postinfarction ventricular tachycardia: assessment of structural and electrical substrate.

Détails

Ressource 1Télécharger: BIB_7AAA0A64B7A7.P001.pdf (1740.58 [Ko])
Etat: Public
Version: Final published version
ID Serval
serval:BIB_7AAA0A64B7A7
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Regional myocardial wall thinning at multidetector computed tomography correlates to arrhythmogenic substrate in postinfarction ventricular tachycardia: assessment of structural and electrical substrate.
Périodique
Circulation. Arrhythmia and Electrophysiology
Auteur(s)
Komatsu Y., Cochet H., Jadidi A., Sacher F., Shah A., Derval N., Scherr D., Pascale P., Roten L., Denis A., Ramoul K., Miyazaki S., Daly M., Riffaud M., Sermesant M., Relan J., Ayache N., Kim S., Montaudon M., Laurent F., Hocini M., Haïssaguerre M., Jaïs P.
ISSN
1941-3084 (Electronic)
ISSN-L
1941-3084
Statut éditorial
Publié
Date de publication
2013
Volume
6
Numéro
2
Pages
342-350
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Résumé
BACKGROUND: A majority of patients undergoing ablation of ventricular tachycardia have implanted devices precluding substrate imaging with delayed-enhancement MRI. Contrast-enhanced multidetector computed tomography (MDCT) can depict myocardial wall thickness with submillimetric resolution. We evaluated the relationship between regional myocardial wall thinning (WT) imaged by MDCT and arrhythmogenic substrate in postinfarction ventricular tachycardia.
METHODS AND RESULTS: We studied 13 consecutive postinfarction patients undergoing MDCT before ablation. MDCT data were integrated with high-density 3-dimensional electroanatomic maps acquired during sinus rhythm (endocardium, 509±291 points/map; epicardium, 716±323 points/map). Low-voltage areas (<1.5 mV) and local abnormal ventricular activities (LAVA) during sinus rhythm were assessed with regard to the WT. A significant correlation was found between the areas of WT <5 mm and endocardial low voltage (correlation-R=0.82; P=0.001), but no such correlation was found in the epicardium. The WT <5 mm area was smaller than the endocardial low-voltage area (54 cm(2) [Q1-Q3, 46-92] versus 71 cm(2) [Q1-Q3, 59-124]; P=0.001). Among a total of 13 060 electrograms reviewed in the whole study population, 538 LAVA were detected and analyzed. LAVA were located within the WT <5 mm (469/538 [87%]) or at its border (100% within 23 mm). Very late LAVA (>100 ms after QRS complex) were almost exclusively detected within the thinnest area (93% in the WT<3 mm).
CONCLUSIONS: Regional myocardial WT correlates to low-voltage regions and distribution of LAVA critical for the generation and maintenance of postinfarction ventricular tachycardia. The integration of MDCT WT with 3-dimensional electroanatomic maps can help focus mapping and ablation on the culprit regions, even when MRI is precluded by the presence of implanted devices.
Mots-clé
Adult, Aged, Arrhythmogenic Right Ventricular Dysplasia/diagnosis, Arrhythmogenic Right Ventricular Dysplasia/physiopathology, Body Surface Potential Mapping, Catheter Ablation/methods, Female, Follow-Up Studies, Heart Conduction System/physiopathology, Heart Conduction System/surgery, Heart Ventricles/pathology, Heart Ventricles/physiopathology, Humans, Imaging, Three-Dimensional, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Multidetector Computed Tomography/methods, Myocardial Infarction/complications, Myocardial Infarction/physiopathology, Myocardium/pathology, Reproducibility of Results, Retrospective Studies
Pubmed
Web of science
Open Access
Oui
Création de la notice
15/07/2014 9:00
Dernière modification de la notice
20/08/2019 15:36
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