Myocardial wall thinning predicts transmural substrate in patients with scar-related ventricular tachycardia

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• 作者：Seigo Yamashita ; MD^* ; ^{seigoy722@yahoo.co.jp} ; Fré ; dé ; ric Sacher ; MD^* ; ^&dagger ; ; Darren A. Hooks ; MD^* ; Benjamin Berte ; MD^* ; Jean-Marc Sellal ; MD^* ; Antonio Frontera ; MD^* ; Nora Al Jefairi ; MD^* ; Yuki Komatsu ; MD^* ; Sana Amraoui ; MD^* ; Arnaud Denis ; MD^* ; ^&dagger ; ; Nicolas Derval ; MD^* ; ^&dagger ; ; Maxime Sermesant ; PhD^&Dagger ; ; Franç ; ois Laurent ; MD^&dagger ; ; ^§ ; ; Michel Montaudon ; MD^&dagger ; ; ^§ ; ; Mé ; lè ; ze Hocini ; MD^* ; ^&dagger ; ; Michel Haï ; ssaguerre ; MD^* ; ^&dagger ; ; Pierre Jaï ; s ; MD^* ; ^&dagger ; ; Hubert Cochet ; MD^&dagger ; ; ^§ ;
• 关键词：Ventricular tachycardia ; Ablation ; Imaging ; Wall thinning ; Multidetector computed tomography
• 刊名：Heart Rhythm
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：14
• 期：2
• 页码：155-163
• 全文大小：1964 K
• 卷排序：14

文摘

Scar-related ventricular tachycardia (VT) arises from specific substrate according to etiology.ObjectiveThe purpose of this study was to evaluate the relationship between wall thinning (WT) on multidetector computed tomography (MDCT) and local abnormal ventricular activity (LAVA) in patients with ischemic cardiomyopathy (ICM), postmyocarditis (PMC), and dilated cardiomyopathy (DCM).MethodsForty-two patients (40 male, age 58 ± 13 years, 22 ICM, 11 PMC, 9 DCM) underwent MDCT before a combined endo-/epicardial VT ablation procedure. WT (<5 mm) and severe wall thinning (SWT) (<2 mm) area on MDCT were compared to the prevalence of endo-/epicardial LAVA during sinus rhythm.ResultsWT and SWT were found on MDCT in 36 (86%) and 20 (48%) with 42 ± 37 cm2 and 26 ± 24 cm2, respectively. SWT was frequently detected in ICM (ICM 77% vs PMC 27% vs DCM 0%, P <.001). LAVA were frequently observed on the endocardium in ICM and on the epicardium in PMC. Endo-/epicardial facing LAVA were frequently found within SWT areas (91% in <2 mm, 9% in 2–5 mm, and 0% in >5 mm, P < .001). In SWT areas, the presence of endocardial LAVA in ICM and epicardial LAVA in PMC predicted opposite facing LAVA with sensitivity and specificity of 78% and 48% and 79% and 98%, respectively. SWT predicted epicardial LAVA in ICM and endocardial LAVA in PMC with sensitivity and specificity of 89% and 100%, and 100% and 100%, respectively.ConclusionSWT is frequently found in ICM and PMC but is not common in DCM. SWT predicts LAVA on the opposite side of the wall (epicardial in ICM and endocardial in PMC), indicating transmural VT substrate. MDCT is useful for identifying VT substrate and helpful for understanding the mechanisms of the location of VT substrate domain.