Author + information
- Received August 16, 2017
- Accepted September 7, 2017
- Published online March 19, 2018.
- Daniele Muser, MDa,
- Pasquale Santangeli, MD, PhDa,
- Jackson J. Liang, DOa,
- Simon A. Castro, MDa,
- Silvia Magnani, MDa,
- Tatsuya Hayashi, MDa,
- Fermin C. Garcia, MDa,
- David S. Frankel, MDa,
- Sanjay Dixit, MDa,
- Erica S. Zado, PA-Ca,
- David Lin, MDa,
- Benoit Desjardins, MD, PhDc,
- David J. Callans, MDa,
- Abass Alavi, MD, PhDb and
- Francis E. Marchlinski, MDa,∗ ()
- aCardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bDivision of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- cDepartment of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Francis E. Marchlinski, Hospital of the University of Pennsylvania, 9 Founders Pavilion–Cardiology, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives This study sought to characterize the electroanatomic (EAM) substrate in patients with cardiac sarcoidosis (CS) and ventricular tachycardia and its relationship to imaging findings of inflammation and fibrosis.
Background CS is characterized by coexistence of active inflammation and replacement fibrosis.
Methods A total of 42 patients with CS based on established criteria and ventricular tachycardia underwent high-density EAM mapping. Abnormal electrograms (EGM) were collected and independently classified as multicomponent fractionated, isolated, late, and split according to standard criteria and regardless of the peak-to-peak bipolar/unipolar voltage. A total of 29 patients (69%) underwent pre-procedural cardiac magnetic resonance (CMR) and positron emission tomography (PET)/computed tomography (CT). The distribution of EAM substrate was correlated with regions of late gadolinium enhancement (LGE) on CMR and increased 18F-fluorodeoxyglucose uptake on PET/CT.
Results Of 21,451 bipolar and unipolar EGM, 4,073 (19%) were classified as abnormal with a predominant distribution in the basal perivalvular segments and interventricular septum. Using the standard bipolar (<1.5 mV) and unipolar (<8.3 mV for left ventricle <5.5 mV for the right) voltage cutoff values, 40% and 22% of the abnormal EGM were located outside the EAM low-voltage areas, respectively. LGE was present in 26 of 29 patients (90%), whereas abnormal 18F-fluorodeoxyglucose uptake in 14 of 29 patients (48%) with imaging. Segments with abnormal EGM had more LGE-evident scar transmurality [median: 24% (interquartile range [IQR]: 4% to 40%) vs. median: 5% (IQR: 0% to 15%); p < 0.001] and lower metabolic activity (median: 20 g glucose [IQR: 14 g to 30 g] vs. median: 29 g glucose [IQR: 18 g to 39 g]; p < 0.001). Overall, the agreement between the presence of abnormal EGM was higher with the presence of LGE (κ = 0.51; p < 0.001) than with the presence of active inflammation (κ = −0.12; p = 0.003).
Conclusions In patients with CS and ventricular tachycardia, pre-procedural imaging with CMR and PET/CT can be useful in detecting EAM abnormalities that are potential targets for substrate ablation. Abnormal EGM were more likely located in segments with more scar transmurality (LGE) at CMR and a lower degree of inflammation on PET.
- cardiac magnetic resonance
- cardiac positron emission tomography/computed tomography
- cardiac sarcoidosis
- electroanatomic mapping
- ventricular tachycardia
This research was funded by the Richard T. and Angela Clark Innovation Fund and the F. Harlan Batrus Research Fund in Cardiac Electrophysiology. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Muser and Santangeli contributed equally to this work, and are joint first authors.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received August 16, 2017.
- Accepted September 7, 2017.
- 2018 American College of Cardiology Foundation
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