Epicardial Conduction Speed, Electrogram Abnormality, and Computed Tomography Attenuation Associations in Arrhythmogenic Right Ventricular Cardiomyopathy
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Author + information
- Tuna Ustunkaya, MD, PhDa,
- Benoit Desjardins, MD, PhDb,
- Riley Wedana,
- C. Anwar A. Chahal, MBChB, PhDa,
- Stefan L. Zimmerman, MDc,
- Nissi Saju, MSNd,
- Sohail Zahid, PhDe,
- Apurva Sharma, MDd,
- Yuchi Han, MDe,
- Natalia Trayanova, PhDf,
- Francis E. Marchlinski, MDa,
- Hugh Calkins, MDd,
- Harikrishna Tandri, MDd and
- Saman Nazarian, MD, PhDa,∗ (saman.nazarian{at}uphs.upenn.edu)
- aCardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bDepartment of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- cRadiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- dCardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- eCardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- fBiomedical Engineering, Johns Hopkins University, Baltimore, Maryland
- ↵∗Address for correspondence:
Dr. Saman Nazarian, Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street/Founders 9, Philadelphia, Pennsylvania 19143.
Central Illustration
Abstract
Objectives This study sought to evaluate the association between contrast-enhanced multidetector computed tomography (CE-MDCT) attenuation and local epicardial conduction speed (ECS) and electrographic abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and ventricular tachycardia (VT).
Background CE-MDCT is a widely available and fast imaging technology with high spatial resolution that is less prone to defibrillator generator−related safety issues and image artifacts. However, the association between hypoattenuation on MDCT and VT substrates in ARVC remains unknown.
Methods Patients with ARVC who underwent CE-MDCT followed by endocardial (n = 30) and epicardial (n = 21) electroanatomical mapping (EAM) and VT ablation were prospectively enrolled. Right ventricular (RV) mid-myocardial attenuation was calculated from 3-dimensional MDCT images and registered to EAM. Local ECS was calculated by averaging the ECS between each point and 5 adjacent points with concordant wave front direction.
Results A total of 17,311 epicardial and 5,204 endocardial points were included. In multivariable regression analysis clustered by patient, RV myocardial attenuation was associated with epicardial bipolar voltage amplitude (2.5% decrease in amplitude per 10 HU decrease in attenuation; p < 0.001), with endocardial unipolar voltage amplitude (0.9% decrease in amplitude per 10 HU decrease in attenuation; p < 0.001), and with ECS (0.4% decrease in ECS per 10 HU decrease in attenuation; p = 0.001).
Conclusions CE-MDCT attenuation distribution is associated with regional ECS and electrographic amplitude in ARVC. Regions with low attenuation likely reflect fibro-fatty involvement in the RV and may serve as important VT substrates in patients with ARVC who are undergoing VT ablation.
- arrhythmogenic right ventricular cardiomyopathy
- conduction speed
- epicardial mapping
- endocardial mapping
- multidetector computed tomography
- ventricular tachycardia ablation
Footnotes
Dr. Nazarian is supported by the National Institutes of Health (NIH) (grants R01HL116280 and R01HL142893). Dr. Trayanova is supported by NIH (grant PD1HL123271) and a grant from the Foundation Leducq. Dr. Zimmerman has been an advisor for Siemens Healthcare. Dr. Nazarian has been a consultant for St. Jude Medical, Siemens, Biosense Webster, and CardioSolv; and has received research funding from Biosense Webster, Imricor, and Siemens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 February 7, 2019.
- Revision received June 28, 2019.
- Accepted June 28, 2019.
- 2019 American College of Cardiology Foundation
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