Integration of MDCT-imaged myocardial fat with 3D-EAM demonstrated good concordance with epicardial low voltage (κ=0.69; 95% CI 0.54-0.84) and localized 80% of abnormal ventricular activities.
Observational (n=16)
Does MDCT-imaged myocardial fat correlate with VT substrate on 3D-EAM in patients with ARVC?
MDCT-imaged myocardial fat correlates well with epicardial low voltage and local abnormal ventricular activities, providing valuable information for localizing VT substrate in ARVC.
Effect estimate: κ 0.69 (95% CI 0.54 to 0.84)
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.
Komatsu et al. (Fri,) conducted a observational in Arrhythmogenic right ventricular cardiomyopathy (ARVC) (n=16). MDCT-imaged myocardial fat integration with 3D-EAM was evaluated on Concordance between epicardial low voltage and fat (κ 0.69, 95% CI 0.54 to 0.84). Integration of MDCT-imaged myocardial fat with 3D-EAM demonstrated good concordance with epicardial low voltage (κ=0.69; 95% CI 0.54-0.84) and localized 80% of abnormal ventricular activities.
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