Association of regional epicardial right ventricular electrogram voltage amplitude and late gadolinium enhancement distribution on cardiac magnetic resonance in patients with arrhythmogenic right ventricular cardiomyopathy: Implications for ventricular tachycardia ablation

作者：Xie, Shuanglun; Desjardins, Benoit; Kubala, Maciej; Liang, Jackson; Yang, Jiandu; van der Geest, Rob J; Schaller, Robert; Riley, Michael; Callans, David; Zado, Erica; Marchlinski, Francis; Nazarian, Saman^*

来源：Heart Rhythm, 2018, 15(7): 987-993.

DOI：10.1016/j.hrthm.2018.02.030

• Arrhythmogenic right ventricular cardiomyopathy/dysplasia
• Epicardial mapping
• Late gadolinium delayed enhancement
• Magnetic resonance imaging
• Scar
• Ventricular tachycardia

BACKGROUND Criteria for identification of anatomic ventricular tachycardia substrates in arrhythmogenic right ventricular cardiomyopathy (ARVC) on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) are unclear.
OBJECTIVE The purpose of this study was to define (1) the association of regional right ventricular (RV) epicardial voltage amplitude with the distribution of LGE; and (2) appropriate image signal intensity (SI) thresholds for ventricular tachycardia substrate identification in ARVC.
METHODS Preprocedural LGE-CMR and epicardial electrogram mapping were performed in 10 ARVC patients. The locations of epicardial electrogram map points, obtained during sinus rhythm with intrinsic conduction or RV pacing, were retrospectively registered to the corresponding LGE image regions. Standardized SI z-scores (standard deviation distance from the mean) were calculated for each 10-mm region surrounding map points.
RESULTS In patient-clustered, generalized estimating equations models that included 3205 epicardial electroanatomic points and corresponding SI measures, bipolar (-1.43 mV/z-score; P <.001) and unipolar voltage amplitude (-1.22 mV/z-score; P C.001) were associated with regional SI z-scores. In contrast to the QRSlate potential (LP) interval (P = .362), the LP activation index, defined as electrogram duration divided by QRS-LP, was associated with regional SI z-scores (P <.001). SI z-score thresholds >0.05 (95% confidence interval -0.05 to 0.15) and <-0.16 (95% confidence interval -0.26 to 0.06) corresponded to bipolar voltage measures <0.5 and >1.0 mV, respectively.
CONCLUSION Increased RV gadolinium uptake is associated with lower epicardial bipolar and unipolar electrogram voltage amplitude. Standardized LGE-CMRSI z-scores may augment preprocedural planning for identification of low-voltage zones and abnormal myocardium in ARVC.

• 出版日期2018-7
• 单位中山大学