scholarly journals Effect of adipose graft transposition procedure (AGTP) on the ischemic arrhythmogenic substrate: an MRI study in a swine model of chronic myocardial infraction

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
R Adelino Recasens ◽  
C Galvez-Monton ◽  
A Teis ◽  
D Martinez-Falguera ◽  
O Rodriguez-Leor ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Sham Group ◽  
Left Ventricular ◽  
Post Treatment ◽  
Border Zone ◽  
Left Ventricular Ejection ◽  
Reparative Therapy ◽  
Arrhythmogenic Substrate ◽  
Myocardial Infraction ◽  
Lge Cmr

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III BACKGROUND Cardiac regenerative therapy is a promising treatment for patients with myocardial infarction (MI) and heart failure. Nevertheless, previous ex-vivo studies have raised concern on the potential increased risk of arrhythmic events following certain cell therapies. Adipose graft transposition procedure (AGTP) is a cardiac reparative therapy consisting in transposing a vascularized adipose flap from the autologous pericardium and placing it over the epicardial scar area and has demonstrated to reduce infarct size and improve the left ventricular ejection fraction in preclinical and human studies. PURPOSE To assess the effect of the AGTP on the post-MI scar composition and image-based ventricular tachycardia (VT) corridors detection by means of late gadolinium enhanced cardiac magnetic resonance (LGE-CMR). METHODS A left circumflex artery (first marginal branch) MI was induced in 9 Landrace X Large White Pigs by delivering 1-3 coils. Two weeks post-MI, all subjects underwent a 3 Tesla LGE-CMR and randomized to the AGTP or sham group. LGE-CMR was repeated 30 days post-treatment (6 weeks post-MI). The arrhythmogenic substrate was characterized with an advanced image post-processing tool (ADAS 3D) and included quantification of dense scar and border zone (BZ) mass and detection of ventricular tachycardia (VT) corridors (including corridor scar mass). RESULTS The overall scar mass did not differ between scans in the overall population (7.6 ± 3.5 g vs 7.5 ± 2.2 g in the baseline and post-treatment scans, respectively; p = 0.9). Compared to the sham subjects, those receiving AGTP showed an absolute reduction of the total (-3.2 ± 1.4 g vs. +2.4 ± 1.7 g, p = 0.04) and dense scar (-0.9 ± 0.4 g vs. +0.7 ± 0.5 g, p = 0.03). BZ mass tended to decrease in the AGTP group (-2.2 vs 1.63 g; p = 0.06). The AGTP group showed a trend to reduce the number of VT corridors (-1 ± 0.7 vs. +0.4 ± 0.2, p = 0.078) and corridor scar mass (-0.3 ± 0.26 g vs. +0.1 ± 0.1 g, p = 0.11) (figure). CONCLUSIONS Cardiac reparative therapy of MI with AGTP reduced dense scar mass, compared to the increase observed in the sham group. The trend to reduce the BZ mass and the number/mass of VT corridors suggests a beneficial effect on the arrhythmic remodeling of the post-MI scar. Abstract Figure. Reduction in corridor"s number

P1111Arrhythmogenic substrate detection in ischemic patients undergoing ventricular tachycardia ablation using multi-detector computed tomography: compared evaluation with cardiac magnetic resonance

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
B Jauregui ◽  
D Soto-Iglesias ◽  
G Zucchelli ◽  
C Teres ◽  
A Ordonez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ventricular Tachycardia ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Predictive Values ◽  
Arrhythmogenic Substrate ◽  
Subendocardial Mi

Abstract Background  Cardiac magnetic resonance (CMR) is capable of accurately identifying arrhythmogenic substrate (AS), leading to longer arrhythmia-free survival when used to guide ventricular tachycardia (VT) substrate ablation procedures. However, the use of CMR may be limited in certain centers or patient subsets.  Purpose  To evaluate the performance of multidetector cardiac computed tomography (MDCT) imaging in identifying heterogeneous tissue channels (HTCs) detected by CMR in ischemic patients undergoing VT substrate ablation. Methods  Thirty ischemic patients undergoing both CMR and MDCT before VT substrate ablation were included. Using a dedicated post-processing software, two blinded operators, assigned either to CMR or MDCT analysis, characterized the presence of CMR- and CT-channels, respectively. CMR-channels were classified as endocardial (layers <50%), epicardial (layers ≥50%) or transmural. CMR- vs. CT-channel concordance was considered when the orientation was the same and they were located in the same AHA segment. Results  Mean age was 69 ± 10 years; 90% were male. Mean left ventricular ejection fraction (LVEF) was 35 ± 10%. All patients had CMR-channels (n = 76), whereas only 26/30 (86.7%) had CT-channels (n = 91). Global sensitivity (Se) and positive predictive values (PPV) for detecting CMR-channels were 61.8% and 51.6%, respectively. MDCT performance improved in patients with epicardial CMR-channels (Se 80.5%), and transmural scars (Se 72.2%). In 4/11 (36%) patients with subendocardial MI, MDCT was unable to identify the AS. Conclusion  MDCT fails to detect the presence of AS in 36% of patients with subendocardial MI and shows a modest sensitivity identifying the presence of HTCs, although its performance improves in patients with transmural scar. Abstract Figure. Multimodality imaging AS detection

Arrhythmogenic substrate detection in chronic ischaemic patients undergoing ventricular tachycardia ablation using multidetector cardiac computed tomography: compared evaluation with cardiac magnetic resonance

EP Europace ◽  
2020 ◽  
Author(s):  
Beatriz Jáuregui ◽  
David Soto-Iglesias ◽  
Giulio Zucchelli ◽  
Diego Penela ◽  
Augusto Ordóñez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ventricular Tachycardia ◽  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Cardiac Computed Tomography ◽  
Left Ventricular Ejection ◽  
Gadolinium Enhancement ◽  
Arrhythmogenic Substrate ◽  
Lge Cmr

Abstract Aims Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits characterizing ischaemic scars, detecting heterogeneous tissue channels (HTCs) which constitute the arrhythmogenic substrate (AS). Late gadolinium enhancement cardiac magnetic resonance also improves the arrhythmia-free survival when used to guide ventricular tachycardia (VT) substrate ablation. However, its availability may be limited. We sought to evaluate the performance of multidetector cardiac computed tomography (MDCT) imaging in identifying HTCs detected by LGE-CMR in ischaemic patients undergoing VT substrate ablation. Methods and results Thirty ischaemic patients undergoing both LGE-CMR and MDCT before VT substrate ablation were included. Using a dedicated post-processing software, two blinded operators, assigned either to LGE-CMR or MDCT analysis, characterized the presence of CMR and computed tomography (CT) channels, respectively. Cardiac magnetic resonance channels were classified as endocardial (layers < 50%), epicardial (layers ≥ 50%), or transmural. Cardiac magnetic resonance- vs. CT-channel concordance was considered when showing the same orientation and American Heart Association (AHA) segment. Mean age was 69 ± 10 years; 90% were male. Mean left ventricular ejection fraction was 35 ± 10%. All patients had CMR channels (n = 76), whereas only 26/30 (86.7%) had CT channels (n = 91). Global sensitivity (Se) and positive predictive values for detecting CMR channels were 61.8% and 51.6%, respectively. MDCT performance improved in patients with epicardial CMR channels (Se 80.5%) and transmural scars (Se 72.2%). In 4/11 (36%) patients with subendocardial myocardial infarction (MI), MDCT was unable to identify the AS. Conclusions Compared to LGE-CMR, myocardial wall thickness assessment using MDCT fails to detect the presence of AS in 36% of patients with subendocardial MI, showing modest sensitivity identifying HTCs but a better performance in patients with transmural scars.

129Magnetic resonance predictors of ventricular tachycardia recurrence after radiofrequency substrate ablation: septal and transmural channels

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Quinto ◽  
F Alarcon ◽  
P Sanchez ◽  
P Garre ◽  
F Zaraket ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Tissue Characterization ◽  
Interventricular Septum ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Border Zone ◽  
Left Ventricle Mass ◽  
Vt Ablation ◽  
Lge Cmr

Abstract   Ventricular tachycardia (VT) substrate-based ablation has become a gold standard in patients with structural heart disease. Success of VT ablation is related with mortality reduction. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is a powerful technique to assess substrate of VT. Myocardial fibrosis is electrically inert (Core) but it is surrounded by a ‘‘border-zone (BZ)’’ where normal cardiomyocytes intermingle with dense bundles of fibrosis. Slow impulse conduction in the BZ allows for the re-entry circuits leading to VT. Both the presence and extent of LGE have been associated with VT and SCD risk. LGE-CMR tissue characterization can be depicted as pixel signal intensity (PSI) maps and can guide VT ablation. The aim of this study was to analyze possible VT recurrence predictors in a long term follow-up of patients that underwent VT ablation (endo and/or epicardial) related with LGE-CMR PSI maps. We analyzed 234 consecutive patients (age: 63.2 ± 14 years, follow-up: 3.14 years ±1.8) undergoing VT ablation with scar-dechannelling technique at a single center from 2013 to 2018.  110 patients underwent a preprocedural LGE-CMR, and in 94 patients (85,5%) a CMR-aided ablation using the PSI maps was performed. All LGE-CMR images were semi-automatically processed using a dedicated software. PSI-based algorithm was applied to characterize the hyperenhanced area as core or BZ, using fixed threshold of the maximum intensity. A LV 3D shell was obtained and were imported into the navigation system. In the PSI maps, heterogenous tissue channels were defined as a continuous corridor of BZ surrounded by scar core or an anatomic barrier that connects 2 areas of healthy tissue. Results Overall recurrence of VT was 41.8 %. There was ICD shock reduction, from 43,6% to a 28,2% (ICD shocks before ablation 2,23 ± 7,32, after: 1,10 ± 2,92). Left ventricle mass predicted significantly VT recurrence (Mean 168,3 ± 53,3 vs 152,3 ± 46,4 g, HR 1,02 [1,01-1,02], p < 0.001). LGE distribuition was predictive of VT recurrence when a more than 40% of the interventricular septum was involved (62,5% vs 37,8%; HR 1,6 [1,01-1,02]; p = 0,044). No differences in recurrence were found among the patterns of LGE distribution (transmural/epicardial/subendocardial or peculiar segments localizations). The amount of BZ and the total amont of Core + BZ was related with VT recurrence (BZ 26,6 ± 13,9 vs 19,56 ± 9,69 g, HR 1,03 [1,01-1,06], p = 0,012; total Core + BZ 37,1 ± 18,2 vs 29,0 ± 16,3 g, HR 1,02 [1,00-1,04], p = 0,033). Finally VT recurrence was higher in patients with channels with transmural path (66,7% vs 31,4%, HR 3,25 [1,70-6,23], p < 0,001) or midmural channels (54,3% vs 27,6%, HR 2,49 [1,21–5,13], p = 0,013). CMR-aided scar dechanneling is a helpful and feasible technique which could identify patients with high risk of VT recurrence. High left ventricular mass, septal LGE distribution, transmural and midmural heterogeneous tissue channels were predictive factors of post ablation VT recurrence. Abstract Figure. VTchannel & heterogeoneus tissue channel

Abstract 2126: Therapeutic Evaluation of Corticosteroid Therapy for Ventricular Tachycardia Associated with Cardiac Sarcoidosis -Application of High Resolution Electrocardiography-

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Kenji Yodogawa ◽  
Yoshihiko Seino ◽  
Norihiko Ono ◽  
Chikao Ibuki ◽  
Toshihiko Ohara ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Corticosteroid Therapy ◽  
Cardiac Sarcoidosis ◽  
Holter Monitoring ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Qrs Complex ◽  
Ventricular Ejection Fraction ◽  
Arrhythmogenic Substrate ◽  
Therapeutic Evaluation

Background The outcome of cardiac sarcoidosis (CS) is sometimes fatal. Ventricular tachycardia (VT) is one of the common causes of sudden death in CS patients. In patients with definite diagnosis of CS, corticosteroid therapy should be the absolute indication. However, little is known about the effectiveness for VT. Further, there is no established method for therapeutic evaluation in CS. Thus, we investigated whether or not VT is suppressed following corticosteroid therapy and the utility of Signal Averaged Electrocardiography (SAECG) for therapeutic assessment in CS patients with VT. Methods Fifteen histological proved CS patients presenting with sustained or non-sustained VT were investigated. All of these patients were treated with predonisolone 30mg to 10mg/day, and assessed before and after corticosteroid therapy. All patients underwent SAECG in which the filtered QRS duration (f-QRS), the root mean square voltage of the terminal 40 ms (RMS 40 ) in the filtered QRS complex and the duration of low-amplitude signals < 40μV (LAS 40 ) in the terminal filtered QRS complex were measured. The presence of VT was assessed by Holter monitoring. Results VT was suppressed in 6 patients {VT (−) group} and the remaining 9 patients were not {VT (+) group}. Accumulation of gallium-67 was detected more frequently in VT (−) group than in VT (+) group (66.7% vs. 11.1%, p<0.05). Left ventricular ejection fraction (LVEF) was significantly higher in VT (−) group than that of VT (−) group (54.1+/−20.1 vs 32.8+/−11.7 p<0.05). In VT (−) group, f-QRS and LAS 40 were significantly decreased and RMS 40 was significantly increased compared with those before corticosteroid therapy (f-QRS: 136.3+/−30.6msec vs 116.8+/−25.4msec, p<0.05 LAS 40 : 68.2+/−24.0msec vs 47.8+/−22.9msec, p<0.05 RMS 40 : 7.2+/−3.3 msec vs 13.3+/−7.6msec, p<0.05). However, SAECG parameters did not change significantly in VT (+) group. Conclusions In the early and viable stage of the disease, corticosteroid therapy was effective for VT in CS. Reversible conduction abnormality detected by SAECG might reflect reversible arrhythmogenic substrate for the occurrence of VT. SAECG is useful for therapeutic evaluation of CS patients with VT.

scholarly journals Combination of Ligusticum Chuanxiong and Radix Paeonia Promotes Angiogenesis in Ischemic Myocardium through Notch Signalling and Mobilization of Stem Cells

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Wei-Li Shi ◽  
Jun Zhao ◽  
Rong Yuan ◽  
Yan Lu ◽  
Qi-Qi Xin ◽  
...  
Keyword(s):  
Stem Cells ◽  
Sham Group ◽  
Left Ventricular ◽  
Notch Signalling ◽  
Ischemic Myocardium ◽  
Border Zone ◽  
Left Ventricular Ejection ◽  
Model Group ◽  
Ventricular Ejection Fraction ◽  
Related Proteins

Objective. To study the cardioprotective mechanism by which the combination of Chuanxiong (CX) and Chishao (CS) promotes angiogenesis. Methods. Myocardial infarction (MI) mouse models were induced by ligation of the left anterior descending coronary artery. The effects on cardiac function were evaluated in the perindopril tert-butylamine group (PB group) (3 mg/kg/d), CX group (55 mg/kg/d), CS group (55 mg/kg/d), and CX and CS combination (CX-CS) group (27.5 mg/kg/d CX plus 27.5 mg/kg/d CS). RO4929097, an inhibitor of Notch γ secretase, was used (10 mg/kg/d) to explore the role of Notch signalling in the CX-CS-induced promotion of angiogenesis in the myocardial infarcted border zone (IBZ). The left ventricular ejection fraction (LVEF) and percentage of MI area were evaluated with animal ultrasound and Masson staining. The average optical densities (AODs) of CD31 and vWF in the myocardial IBZ were detected by immunofluorescence. Angiogenesis-related proteins including hypoxia-inducible factor 1-alpha (HIF-1α), fibroblast growth factor receptor 1 (FGFR-1), Notch1 and Notch intracellular domain (NICD), and stem cell mobilization-related proteins including stromal cell-derived factor 1 (SDF-1), C-X-C chemokine receptor type 4 (CXCR-4), and cardiotrophin1 were detected by western blot analysis. Results. Compared with the model group, the CX-CS and PB groups both showed markedly improved LVEF and decreased percentage of MI area after 21 days of treatment. Although the CX group and CS group showed increased LVEF and decreased MI areas compared with the model group, the difference was not significant. The AOD of CD31 in the IBZ in both the model and the CX-CS-I group was markedly reduced compared with that in the sham group. CX-CS significantly increased the CD31 AOD in the IBZ and decreased the AODs of CD31 and vWF in the infarct zone compared with those in the model group. The expression of HIF-1α in both the model group and the CX-CS group was higher than that in the sham group. Compared with the model group, the expression of FGFR-1, SDF-1, cardiotrophin1, Notch1, and NICD was increased in the CX-CS group. Notch1 and NICD expression in the CX-CS-I group was reduced compared with that in the CX-CS group. Conclusions. The combination of CX and CS protected cardiomyocytes in the IBZ better than CX or CS alone. The mechanism by which CX-CS protects ischemic myocardium may be related to the proangiogenesis effect of CX-CS exerted through Notch signalling and the mobilization of stem cells to the IBZ.

scholarly journals Cardiac reparative therapy with adipose graft transposition procedure reduces slow conduction areas in a chronic myocardial infarction swine model

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
R Adelino Recasens ◽  
C Galvez-Monton ◽  
D Martinez-Falguera ◽  
C Curiel ◽  
R Marsal ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Conduction Velocity ◽  
Sham Group ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Left Ventricular Ejection ◽  
Reparative Therapy ◽  
Electrophysiological Properties ◽  
Slow Conduction

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Insituto de Salud Carlos III BACKGROUND Cardiac regenerative therapy is a promising treatment for patients with ischemic heart disease, but there are some concerns on the potential increased risk of arrhythmic events following specific cell therapies. Adipose graft transposition procedure (AGTP) is a cardiac reparative therapy consisting in transposing a vascularized adipose flap from the autologous pericardium and placing it over the epicardial scar area and has demonstrated to reduce infarct size and improve the left ventricular ejection fraction in preclinical and human studies. Specific electrophysiological properties of the scar, (i.e. slow conduction velocity (CV)) have been identified as key features of ventricular tachycardia (VT) isthmuses. PURPOSE To assess the effect of the AGTP on VT inducibility and the electrophysiological properties of the post-MI scar with ultra-high density (UHD) mapping. METHODS A left circumflex artery (first marginal branch) MI was induced in 10 Landrace X Large White pigs by delivering 1-3 coils. Two weeks post-MI, all subjects underwent baseline left ventricular endocardial UHD mapping during right ventricular pacing with 64-electrode basket mapping catheter, as well as electrophysiological study (EPS) to test for VT inducibility.  Following the mapping, subjects were allocated 1:1 to AGTP or sham group. UHD mapping and EPS were repeated 30 days post-treatment (6 weeks after MI). Voltage and activation maps were analyzed off-line with self-customized Paraview-based software. Voltage cut-offs of 1.5 and 0.5mV (bipolar) defined normal tissue, border zone (BZ) and dense scar, respectively, and 6.7mV for unipolar. Conduction velocity (CV) was determined for every pair of contiguous points and areas of similar CV were quantified for every 0.2m/s steps (for up to 4 m/s). RESULTS There were no differences between groups with regard of dense scar, BZ an low unipolar voltage areas. The AGTP group had a significant reduction of the size of slow CV (&lt;0.2 m/s) areas, compared to the sham group in whom it increased (-4.1 ± 1.7 vs. +2.4 ± 1.6 mm2, p = 0.028)(Figure). There were no differences in the size of other ranges of CV. EPS did not induce VT in any subject at baseline, and only in 1 of the sham group at the follow-up EPS. CONCLUSIONS Cardiac reparative therapy with AGTP of post-MI scar reduced the size of slow conduction areas and could provide a protective effect against arrhythmic events in ischemic heart disease. Abstract Figure.

P1106Fundamental differences and predictors of scar arrhythmogenicity in ischemic patients using cardiac magnetic resonance: a propensity score-matching study

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
B Jauregui ◽  
D Soto-Iglesias ◽  
C Teres ◽  
A Ordonez ◽  
A Chauca ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Independent Predictor ◽  
Left Ventricular ◽  
Curve Analysis ◽  
Border Zone ◽  
Left Ventricular Ejection ◽  
Lge Cmr

Abstract Introduction  Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits to identify the arrhythmogenic substrate (AS) in ischemic patients. However, it is unknown why the majority of them never develop ventricular tachycardias (VT), irrespectively of their left ventricular ejection fraction (LVEF).  Purpose  To characterize the fundamental differences and potential predictors of scar arrhythmogenicity in post-myocardial infarction (MI) patients with and without VT. Methods  36 consecutive ischemic patients with no arrhythmia evidence underwent a LGE-CMR study 4 years after the MI (controls). Scar data were compared with those obtained from 49 ischemic patients referred for VT substrate ablation (cases). Propensity score matching (PSM) was performed to adjust for age, LVEF, scar mass, and time from MI. The myocardium was segmented in 10 layers (endo- to epicardium), characterizing the core, border zone (BZ) and BZ channels (BZCs) using a dedicated post-processing software. Results  Compared to controls, cases were significantly older (67.3 ± 9.1 vs. 56.5 ± 11), had lower LVEF (33.1 ± 10.1 vs. 51 ± 9.4), greater scar mass (33.9 ± 17.2 vs. 14.2 ± 11.6 g), BZ mass (21.1 ± 9.9 vs. 9.6 ± 7.6 g), core mas (12.6 ± 8.8 vs. ± g), number of BZC (2.9 ± 1.4 vs. 1.1 ± 1.1) and BZC mass (10.5 ± 4.2 vs. 2.3 ± 2.4 g) (p &lt; 0.001 in all cases). After PSM (2:1) adjustment[BJG1] , cases had more BZCs (2.9 ± 1.4 vs. 2.2 ± 0.6; p = 0.01) and a greater BZC mass (10.5 ± 4.2 vs. 4.6 ± 2.6 g; p &lt; 0.001). In the multivariable logistic regression analysis, the BZC mass was the only independent predictor of being a case [OR 2.3 (1.5–3.4); p &lt; 0.001]. Receiver operating characteristic curve analysis identified a cut-off point of BZC mass &gt;4.28 g (AUC 0.98; p &lt; 0.001), showing 100% sensitivity and 91% specificity for cases’ discrimination. Conclusions  Compared with the cases, an otherwise similar control group (PS-matched for age, LVEF, scar mass, and time from MI) showed fewer BZC and a reduced BZC mass. BZC mass was the only independent predictor of being a case. A BZC mass cut-off point of &gt; 4.28 g showed a 100% sensitivity and 91% specificity for the identification of ischemic patients with documented VT. Abstract Figure. Mean BZC mass and ROC curve analysis

Cardiovascular magnetic resonance determinants of ventricular arrhythmic events after myocardial infarction

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
B Jauregui ◽  
D Soto-Iglesias ◽  
D Penela ◽  
J Acosta ◽  
J Fernandez-Armenta ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Magnetic Resonance ◽  
Risk Stratification ◽  
Left Ventricular ◽  
Border Zone ◽  
Left Ventricular Ejection ◽  
Post Processing ◽  
Mass Model ◽  
Core Mass ◽  
Lge Cmr

Abstract Funding Acknowledgements Type of funding sources: None. Background  Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits to identify the arrhythmogenic substrate in chronic post-myocardial infarction (MI) patients. It is unknown why a minority of chronic post-MI patients develop sustained ventricular tachycardias (VT) over follow-up, regardless of their left ventricular ejection fraction (LVEF). Objectives  To noninvasively characterize scar differences and potential predictors of VT occurrence in chronic post-MI patients. Methods  A case-control study was designed through retrospective LGE-CMR data analysis of chronic post-MI patients i) consecutively referred for VT substrate ablation after a first VT episode (n = 66), and ii) from a control group (n = 84) with no arrhythmia evidence. The myocardium was characterized differentiating core, border zone (BZ) and BZ channels (BZC) using the ADAS 3D post-processing imaging platform. Clinical and scar characteristics, including a novel parameter, the BZC mass, were compared between both groups. Results  150 post-MI patients were included for analysis. Four multivariate Cox proportional hazards regression models were created for total scar mass (model 1), BZ mass (model 2), core mass (model 3), and BZC mass (model 4, see table). All of them were adjusted by age, sex, and LVEF. In the corresponding models, only total scar mass, BZ mass, core mass, and BZC mass were independent variables associated with the development of VT. BZC mass showed the best performance: a cut-off of 5.15 g identified the cases with 92.4% sensitivity and 86.9% specificity  [AUC 0.93 (0.89–0.97); p &lt; 0.001], with a significant increase in the AUC compared to the other scar parameters (p &lt; 0.001 for all pairwise comparisons using the De Long’s test). By using BZC mass as a risk stratification parameter together with LVEF, the net reclassification improvement (NRI) was 33.3% for the cases, and 39.3% for the controls. The net proportion of patients reclassified correctly was 36.7% Conclusions  The mass of BZC, automatically obtained with a commercially available CMR post-processing software, is the strongest independent variable associated with the occurrence of clinical SMVT in post-MI patients after covariate adjustment for age, sex, and LVEF. The measurement of BZC mass could permit a more accurate arrhythmia risk stratification than LVEF in chronic post-MI patients (NRI 36.7%). Scar characteristics analyzed from LGE-CMR imaging should be taken into consideration to better stratify ventricular arrhythmia risk in chronic post-MI patients. Abstract Figure. ROC curves for predicting VT occurrence

Ventricular tachycardia ablation in nonischemic cardiomyopathy

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Nascimento Matos ◽  
D Cavaco ◽  
P Carmo ◽  
MS Carvalho ◽  
G Rodrigues ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Left Ventricular ◽  
Scientific Development ◽  
Left Ventricular Ejection ◽  
Drug Resistant ◽  
Nonischemic Cardiomyopathy ◽  
Epicardial Ablation ◽  
Ventricular Ejection Fraction ◽  
Ventricular Tachycardia Ablation

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Catheter ablation outcomes for drug-resistant ventricular tachycardia (VT) in nonischemic cardiomyopathy (NICM) are suboptimal when compared to ischemic cardiomyopathy. We aimed to analyse the long-term efficacy and safety of percutaneous catheter ablation in this subset of patients. METHODS Single-center observational retrospective registry including consecutive NICM patients who underwent catheter ablation for drug-resistant VT during a 10-year period. The efficacy endpoint was defined as VT-free survival after catheter ablation, while safety outcomes were defined by 30-days mortality and procedure-related complications. Independent predictors of VT recurrence were assessed by Cox regression. RESULTS In a population of 68 patients, most were male (85%), mean left ventricular ejection fraction (LVEF) was 34 ± 12%, and mean age was 58 ± 15 years. All patients had an implantable cardioverter-defibrillator. Twenty-six (38%) patients underwent epicardial ablation (table 1). Over a median follow-up of 3 years (IQR 1-8), 41% (n = 31) patients had VT recurrence and 28% died (n = 19). Multivariate survival analysis identified LVEF (HR= 0.98; 95%CI 0.92-0.99, p = 0.046) and VT storm at presentation (HR = 2.38; 95%CI 1.04-5.46, p = 0.041) as independent predictors of VT recurrence. The yearly rates of VT recurrence and overall mortality were 21%/year and 10%/year, respectively. No patients died at 30-days post-procedure, and mean hospital length of stay was 5 ± 6 days. The complication rate was 7% (n = 5, table 1), mostly in patients undergoing epicardial ablation (4 vs 1 in endocardial ablation, P = 0.046). CONCLUSION LVEF and VT storm at presentation were independent predictors of VT recurrence in NICM patients after catheter ablation. While clinical outcomes can be improved with further technical and scientific development, a tailored endocardial/epicardial approach was safe, with low overall number of complications and no 30-days mortality. Abstract Figure.

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