Are wall thickness channels defined by computed tomography predictive of isthmuses of postinfarction ventricular tachycardia?

Wall thickness (WT) in post-myocardial infarction scar is heterogenous, with channels of relatively preserved thickness bordered by thinner scar. This study sought to determine whether 3-dimensionally-reconstructed computed tomography (CT) channels correlate with electrophysiological isthmuses durin...

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Bibliographic Details
Published in:Heart rhythm Vol. 16; no. 11; p. 1661
Main Authors: Takigawa, Masateru, Duchateau, Josselin, Sacher, Frederic, Martin, Ruairidh, Vlachos, Konstantinos, Kitamura, Takeshi, Sermesant, Maxime, Cedilnik, Nicolas, Cheniti, Ghassen, Frontera, Antonio, Thompson, Nathaniel, Martin, Calire, Massoullie, Gregoire, Bourier, Felix, Lam, Anna, Wolf, Michael, Escande, William, André, Clémentine, Pambrun, Thomas, Denis, Arnaud, Derval, Nicolas, Hocini, Meleze, Haissaguerre, Michel, Cochet, Hubert, Jaïs, Pierre
Format: Journal Article
Language:English
Published: United States 01.11.2019
Subjects:
Cicatrix - physiopathology
Contrast Media
Electrophysiologic Techniques, Cardiac
Female
Heart Conduction System - physiopathology
Humans
Imaging, Three-Dimensional
Male
Middle Aged
Myocardial Infarction - complications
Retrospective Studies
Tachycardia, Ventricular - diagnostic imaging
Tachycardia, Ventricular - etiology
Tomography, X-Ray Computed - methods
Myocardial infarction
MUSIC
Contrast-enhanced multidetector computed tomography
Ventricular tachycardia
High-resolution mapping
Isthmus
Wall thickness
ISSN:1556-3871, 1556-3871
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Summary:Wall thickness (WT) in post-myocardial infarction scar is heterogenous, with channels of relatively preserved thickness bordered by thinner scar. This study sought to determine whether 3-dimensionally-reconstructed computed tomography (CT) channels correlate with electrophysiological isthmuses during ventricular tachycardia (VT). We retrospectively studied 9 postinfarction patients (aged 57 ± 15 years, 1 female) with 10 complete VT activation maps (cycle length 429 ± 77ms) created using high-resolution mapping. Three-dimensionally-reconstructed WT maps from CT were merged with the activation map during sinus rhythm (SR) and VT. The relationship between WT and electrophysiological characteristics was analyzed. A total of 41 CT channels were identified (median 4 per patient), of median (range) length 21.2 mm (17.3-36.8 mm), width 9.0 mm (6.7-16.5 mm), and area 1.49 cm (1.00-1.75 cm ). WT in the channel was significantly thicker in the center than in the edge (median 2.4 mm vs 1.5 mm, P < .0001). Of 3163 (2493-5960) mapping points in SR, 382 (191-1115) local abnormal ventricular activities (LAVAs) were identified. One patient had a maximal proportion of LAVAs in 3-4 mm, 3 patients in 2-3 mm, 2 in 1-2 mm, and 2 in 0-1 mm. The VT isthmuses of all 10 VTs corresponded with 1-4 CT channels. Twenty-one of the 41 CT channels (51.2%) corresponded to a VT isthmus (entrance, mid, or exit). Electrophysiological VT isthmuses were more likely to be associated with CT channels that were longer (P = .04, odds ratio [OR] 1.05/mm), thinner (but not less than 1 mm) (P = .03, OR 0.36/mm), or parallel to the mitral annulus (P = .07, OR 3.93). VT isthmuses were always found in CT channels (100% sensitivity), and half of CT channels hosted VT isthmuses (positive predictive value 51%). Longer and thinner (but >1 mm) CT channels were significantly associated with VT isthmuses.
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ISSN:1556-3871
1556-3871
DOI:10.1016/j.hrthm.2019.06.012