Key result
Higher scar transmurality on late gadolinium-enhanced MRI was associated with fractionated and isolated potentials (P<0.0001), with most VT circuit sites located in scar with >25% transmurality.
Why the study?
Are nonischemic scar features on LGE-CMR associated with local ventricular electrograms and VT circuit sites in patients with nonischemic cardiomyopathy?
Observational (n=15)
Are nonischemic scar features on LGE-CMR associated with local ventricular electrograms and VT circuit sites in patients with nonischemic cardiomyopathy?
Scar morphology and distribution on LGE-CMR correlate with local electrogram features, potentially guiding procedural strategies like epicardial access for VT ablation in nonischemic cardiomyopathy.
LGE-CMR scar transmurality correlates with abnormal electrograms and VT sites in NICM; leaves open whether imaging refines ablation outcomes.
BACKGROUND: The association of local electrogram features with scar morphology and distribution in nonischemic cardiomyopathy has not been investigated. We aimed to quantify the association of scar on late gadolinium-enhanced cardiac magnetic resonance with local electrograms and ventricular tachycardia circuit sites in patients with nonischemic cardiomyopathy. METHODS AND RESULTS: Fifteen patients with nonischemic cardiomyopathy underwent late gadolinium-enhanced cardiac magnetic resonance before ventricular tachycardia ablation. The transmural extent and intramural types (endocardial, midwall, epicardial, patchy, transmural) of scar were measured in late gadolinium-enhanced cardiac magnetic resonance short-axis planes. Electroanatomic map points were registered to late gadolinium-enhanced cardiac magnetic resonance images. Myocardial wall thickness, scar transmurality, and intramural scar types were independently associated with electrogram amplitude, duration, and deflections in linear mixed-effects multivariable models, clustered by patient. Fractionated and isolated potentials were more likely to be observed in regions with higher scar transmurality (P<0.0001 by ANOVA) and in regions with patchy scar (versus endocardial, midwall, epicardial scar; P<0.05 by ANOVA). Most ventricular tachycardia circuit sites were located in scar with >25% scar transmurality. CONCLUSIONS: Electrogram features are associated with scar morphology and distribution in patients with nonischemic cardiomyopathy. Previous knowledge of electrogram image associations may optimize procedural strategies including the decision to obtain epicardial access.
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Sasaki et al. (2013) conducted an observational in Nonischemic cardiomyopathy (n=15). Late gadolinium-enhanced cardiac magnetic resonance was evaluated on Association of scar transmurality and intramural types with electrogram amplitude, duration, and deflections (p=<0.0001). Higher scar transmurality on late gadolinium-enhanced MRI was associated with fractionated and isolated potentials (P<0.0001), with most VT circuit sites located in scar with >25% transmurality.
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