Conduction velocity was inversely associated with LGE-CMR fibrosis density in patients with ischemic cardiomyopathy, decreasing by 1.34-fold (95% CI, 1.25-1.43) per 25% increase in LGE intensity.
Observational (n=11)
Is myocardial conduction velocity associated with scar distribution on LGE-CMR in patients with ischemic cardiomyopathy?
Conduction velocity is inversely associated with LGE-CMR fibrosis density in patients with ischemic cardiomyopathy, suggesting noninvasive conduction velocity maps derived from LGE-CMR could improve ventricular tachycardia ablation planning.
Effect estimate: 1.34-fold decrease per 25% increase in LGE intensity (95% CI 1.25-1.43)
Absolute Event Rate: 0.41% vs 0.65%
BACKGROUND: Characterizing myocardial conduction velocity (CV) in patients with ischemic cardiomyopathy (ICM) and ventricular tachycardia (VT) is important for understanding the patient-specific proarrhythmic substrate of VTs and therapeutic planning. The objective of this study is to accurately assess the relation between CV and myocardial fibrosis density on late gadolinium-enhanced cardiac magnetic resonance imaging (LGE-CMR) in patients with ICM. METHODS: We enrolled 6 patients with ICM undergoing VT ablation and 5 with structurally normal left ventricles (controls) undergoing premature ventricular contraction or VT ablation. All patients underwent LGE-CMR and electroanatomic mapping (EAM) in sinus rhythm (2960 electroanatomic mapping points analyzed). We estimated CV from electroanatomic mapping local activation time using the triangulation method that provides an accurate estimate of CV as it accounts for the direction of wavefront propagation. We evaluated the association between LGE-CMR intensity and CV with multilevel linear mixed models. RESULTS: Median CV in patients with ICM and controls was 0.41 m/s and 0.65 m/s, respectively. In patients with ICM, CV in areas with no visible fibrosis was 0.81 m/s (95% CI, 0.59-1.12 m/s). For each 25% increase in normalized LGE intensity, CV decreased by 1.34-fold (95% CI, 1.25-1.43). Dense scar areas have, on average, 1.97- to 2.66-fold slower CV compared with areas without dense scar. Ablation lesions that terminated VTs were localized in areas of slow conduction on CV maps. CONCLUSIONS: CV is inversely associated with LGE-CMR fibrosis density in patients with ICM. Noninvasive derivation of CV maps from LGE-CMR is feasible. Integration of noninvasive CV maps with electroanatomic mapping during substrate mapping has the potential to improve procedural planning and outcomes. Visual Overview: A visual overview is available for this article.
Aronis et al. (Thu,) conducted a observational in Ischemic cardiomyopathy and ventricular tachycardia (n=11). Late gadolinium-enhanced cardiac magnetic resonance imaging (LGE-CMR) and electroanatomic mapping vs. Controls with structurally normal left ventricles was evaluated on Association between LGE-CMR intensity and conduction velocity (1.34-fold decrease per 25% increase in LGE intensity, 95% CI 1.25-1.43). Conduction velocity was inversely associated with LGE-CMR fibrosis density in patients with ischemic cardiomyopathy, decreasing by 1.34-fold (95% CI, 1.25-1.43) per 25% increase in LGE intensity.
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