Author + information
- Received October 23, 2019
- Revision received April 17, 2020
- Accepted April 20, 2020
- Published online September 21, 2020.
- Jeroen Venlet, MDa,
- Qian Tao, PhDb,∗,
- Michiel A. de Graaf, MD, PhDa,
- Claire A. Glashan, MDa,
- Marta de Riva Silva, MDa,
- Rob J. van der Geest, PhDb,
- Arthur J. Scholte, MD, PhDa,
- Sebastiaan R.D. Piers, MD, PhDa and
- Katja Zeppenfeld, MD, PhDa,∗ ()
- aDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- bDivision of Image Processing (LKEB), Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- ↵∗Address for correspondence:
Dr. Katja Zeppenfeld, Leiden University Medical Center, Department of Cardiology (C-05-P), P.O. Box 9600, 2300 RC Leiden, the Netherlands.
Objectives This study sought to evaluate whether right ventricular (RV) tissue heterogeneity on computed tomography (CT): 1) is associated with conduction delay in arrhythmogenic right ventricular cardiomyopathy (ARVC); and 2) distinguishes patients with ARVC from those with exercise-induced arrhythmogenic remodeling (EIAR) and control individuals.
Background ARVC is characterized by fibrofatty replacement, related to conduction delay and ventricular tachycardias. Distinguishing ARVC from acquired, EIAR is challenging.
Methods Patients with ARVC or EIAR and combined endocardial-epicardial electroanatomic voltage mapping for VT ablation with CT integration were enrolled. Patients without structural heart disease served as control individuals. Tissue heterogeneity on CT (CT heterogeneity) was automatically quantified within the 2-mm subepicardium of the entire RV free wall at normal sites and low voltage sites harboring late potentials (LP+) in ARVC/EIAR.
Results Seventeen patients with ARVC (15 males; age: 50 ± 17 years), 9 patients with EIAR (7 males; age: 45 ± 14 years) and 17 control individuals (14 males; age: 50 ± 15 years) were enrolled. Of 5,215 ARVC mapping points, 560 (11%) showed LP+. CT heterogeneity was higher at sites with LP+ compared to normal sites (median: 31 HU/mm; IQR: 23 to 46 HU/mm vs. median: 16 HU/mm; IQR: 13 to 21 HU/mm; p < 0.001). The optimal CT heterogeneity cutoff for detection of LP+ was 25 HU/mm (area under the curve [AUC]: 0.80; sensitivity: 72%; specificity: 78%). Overall CT heterogeneity allowed highly accurate differentiation between patients with ARVC and control individuals (AUC: 0.97; sensitivity: 100%; specificity: 82%) and between ARVC and EIAR (AUC: 0.78; sensitivity: 65%; specificity: 89%).
Conclusions In patients with ARVC, tissue heterogeneity on CT can be used to identify LP+ as a surrogate for ventricular tachycardia substrate. The overall tissue heterogeneity on CT allows the distinguishing of patients with ARVC from those with EIAR and control individuals.
- arrhythmogenic right ventricular cardiomyopathy
- catheter mapping and ablation
- computerized tomography
↵∗ Drs. Venlet and Tao contributed equally to this work and are joint first authors.
The Department of Cardiology, Leiden University Medical Center, has received unrestricted research grants from Edwards Lifesciences, Medtronik, Biotronik, Boston Scientific, and Biosense Webster. The 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 October 23, 2019.
- Revision received April 17, 2020.
- Accepted April 20, 2020.
- 2020 American College of Cardiology Foundation
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