Key result
Ring-like LGE linked to ~24-fold higher risk of VT recurrence after ablation.
Why the study?
The arrhythmic substrate and outcomes after ventricular tachycardia ablation in patients with nondilated left ventricular cardiomyopathy remained undefined.
Does the presence of ring-like late gadolinium enhancement (RL-LGE) predict VT recurrence after ablation in patients with nondilated left ventricular cardiomyopathy?
Cohort (n=37)
No
Does the presence of ring-like late gadolinium enhancement (RL-LGE) predict VT recurrence after ablation in patients with nondilated left ventricular cardiomyopathy?
Hazard Ratio: 24 (95% CI 2.8–207.1)
p-value: p=0.004
In patients with nondilated left ventricular cardiomyopathy undergoing VT ablation, the presence of ring-like late gadolinium enhancement on CMR is associated with a more complex arrhythmogenic substrate and a significantly higher risk of VT recurrence.
Characterizes VT substrate and recurrence in NDLVC; leaves open optimal ablation strategies pending prospective trials.
BACKGROUND: Nondilated left ventricular cardiomyopathy (NDLVC) is characterized by an elevated arrhythmic burden and frequent presence of ring-like late gadolinium enhancement (RL-LGE) pattern. However, the arrhythmic substrate and outcomes after ventricular tachycardia (VT) ablations remain undefined. OBJECTIVES: This study sought to characterize the arrhythmogenic substrate using postprocessed cardiac magnetic resonance and assess VT recurrence after ablation in patients with NDLVC. METHODS: Consecutive patients with NDLVC undergoing VT ablation at the Hospital Clínic of Barcelona were included. RESULTS: Thirty-seven patients were included (age 44 years [IQR: 39-55]; 78% male; left ventricular ejection fraction 45% [IQR: 40-52]). RL-LGE was observed in 21 of 37 (57%) patients. Compared with patients without it, patients with RL-LGE had lower left ventricular ejection fraction (40% [38% to 45%] vs 51% [49% to 55%], P < 0.0001), greater scar burden (16.2% [12.7% to 20.0%] vs 5.4% [5.0% to 6.0%], P < 0.0001), larger number of arrhythmogenic conducting channels (3 [2-4] vs 1 [1-2], P < 0.0001), and longer conducting channels (34 mm [29-38 mm] vs 12 mm [10-14 mm], P < 0.0001). Over a median of 3 years of follow-up, 30% of patients had VT recurrence with event rate of 10.2%/year. Dense scar (HR: 1.13, per 1% increment; 95% CI: 1.05-1.22; P = 0.002) and borderzone scar burden (HR: 1.27; 95% CI: 1.11-1.45; P = 0.001), number (HR: 2.35; 95% CI: 1.42-3.91; P = 0.001) and the length of conducting channels (HR: 1.04 per 1 mm increase; 95% CI: 1.01-1.06; P = 0.006) were associated with VT recurrence. The adjusted risk of VT recurrence was 24-fold higher in patients with RL-LGE (HR: 24.0; 95% CI: 2.8-207.1; P = 0.004). CONCLUSIONS: RL-LGE identifies patients with NDLVC with a more complex arrhythmogenic substrate and a poorer outcome after VT ablation.
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Pittorru et al. (2026) conducted a cohort in Nondilated left ventricular cardiomyopathy (NDLVC) (n=37). Ring-like late gadolinium enhancement (RL-LGE) vs. No RL-LGE was evaluated on Ventricular tachycardia recurrence (HR 24.0, 95% CI 2.8-207.1, p=0.004). Ring-like late gadolinium enhancement was associated with a 24-fold higher risk of ventricular tachycardia recurrence after ablation (HR 24.0; 95% CI 2.8-207.1; P=0.004).
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