Impact of nonischemic scar features on local ventricular electrograms and scar-related ventricular tachycardia circuits in patients with nonischemic cardiomyopathy

Takeshi Sasaki, Christopher F. Miller, Rozann Hansford, Vadim Zipunnikov, Menekhem M. Zviman, Joseph E. Marine, David Spragg, Alan Cheng, Harikrishna Tandri, Sunil Sinha, Aravindan Kolandaivelu, Stefan L. Zimmerman, David A. Bluemke, Gordon F. Tomaselli, Ronald D. Berger, Henry R. Halperin, Hugh Calkins, Saman Nazarian

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background-The association of local electrogram features with scar morphology and distribution in nonischemic cardiomyopathy has not been investigated. We aimed to quantify the association of scar on late gadolinium-enhanced cardiac magnetic resonance with local electrograms and ventricular tachycardia circuit sites in patients with nonischemic cardiomyopathy. Methods and Results-Fifteen patients with nonischemic cardiomyopathy underwent late gadolinium-enhanced cardiac magnetic resonance before ventricular tachycardia ablation. The transmural extent and intramural types (endocardial, midwall, epicardial, patchy, transmural) of scar were measured in late gadolinium-enhanced cardiac magnetic resonance short-axis planes. Electroanatomic map points were registered to late gadolinium-enhanced cardiac magnetic resonance images. Myocardial wall thickness, scar transmurality, and intramural scar types were independently associated with electrogram amplitude, duration, and deflections in linear mixed-effects multivariable models, clustered by patient. Fractionated and isolated potentials were more likely to be observed in regions with higher scar transmurality (P<0.0001 by ANOVA) and in regions with patchy scar (versus endocardial, midwall, epicardial scar; P<0.05 by ANOVA). Most ventricular tachycardia circuit sites were located in scar with >25% scar transmurality. Conclusions-Electrogram features are associated with scar morphology and distribution in patients with nonischemic cardiomyopathy. Previous knowledge of electrogram image associations may optimize procedural strategies including the decision to obtain epicardial access.

Original languageEnglish (US)
Pages (from-to)1139-1147
Number of pages9
JournalCirculation: Arrhythmia and Electrophysiology
Volume6
Issue number6
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

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Ventricular Tachycardia
Cardiomyopathies
Cicatrix
Gadolinium
Magnetic Resonance Spectroscopy

Keywords

  • Tachycardia
  • Ventricular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Impact of nonischemic scar features on local ventricular electrograms and scar-related ventricular tachycardia circuits in patients with nonischemic cardiomyopathy. / Sasaki, Takeshi; Miller, Christopher F.; Hansford, Rozann; Zipunnikov, Vadim; Zviman, Menekhem M.; Marine, Joseph E.; Spragg, David; Cheng, Alan; Tandri, Harikrishna; Sinha, Sunil; Kolandaivelu, Aravindan; Zimmerman, Stefan L.; Bluemke, David A.; Tomaselli, Gordon F.; Berger, Ronald D.; Halperin, Henry R.; Calkins, Hugh; Nazarian, Saman.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 6, No. 6, 01.12.2013, p. 1139-1147.

Research output: Contribution to journalArticle

Sasaki, T, Miller, CF, Hansford, R, Zipunnikov, V, Zviman, MM, Marine, JE, Spragg, D, Cheng, A, Tandri, H, Sinha, S, Kolandaivelu, A, Zimmerman, SL, Bluemke, DA, Tomaselli, GF, Berger, RD, Halperin, HR, Calkins, H & Nazarian, S 2013, 'Impact of nonischemic scar features on local ventricular electrograms and scar-related ventricular tachycardia circuits in patients with nonischemic cardiomyopathy', Circulation: Arrhythmia and Electrophysiology, vol. 6, no. 6, pp. 1139-1147. https://doi.org/10.1161/CIRCEP.113.000159
Sasaki, Takeshi ; Miller, Christopher F. ; Hansford, Rozann ; Zipunnikov, Vadim ; Zviman, Menekhem M. ; Marine, Joseph E. ; Spragg, David ; Cheng, Alan ; Tandri, Harikrishna ; Sinha, Sunil ; Kolandaivelu, Aravindan ; Zimmerman, Stefan L. ; Bluemke, David A. ; Tomaselli, Gordon F. ; Berger, Ronald D. ; Halperin, Henry R. ; Calkins, Hugh ; Nazarian, Saman. / Impact of nonischemic scar features on local ventricular electrograms and scar-related ventricular tachycardia circuits in patients with nonischemic cardiomyopathy. In: Circulation: Arrhythmia and Electrophysiology. 2013 ; Vol. 6, No. 6. pp. 1139-1147.
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abstract = "Background-The association of local electrogram features with scar morphology and distribution in nonischemic cardiomyopathy has not been investigated. We aimed to quantify the association of scar on late gadolinium-enhanced cardiac magnetic resonance with local electrograms and ventricular tachycardia circuit sites in patients with nonischemic cardiomyopathy. Methods and Results-Fifteen patients with nonischemic cardiomyopathy underwent late gadolinium-enhanced cardiac magnetic resonance before ventricular tachycardia ablation. The transmural extent and intramural types (endocardial, midwall, epicardial, patchy, transmural) of scar were measured in late gadolinium-enhanced cardiac magnetic resonance short-axis planes. Electroanatomic map points were registered to late gadolinium-enhanced cardiac magnetic resonance images. Myocardial wall thickness, scar transmurality, and intramural scar types were independently associated with electrogram amplitude, duration, and deflections in linear mixed-effects multivariable models, clustered by patient. Fractionated and isolated potentials were more likely to be observed in regions with higher scar transmurality (P<0.0001 by ANOVA) and in regions with patchy scar (versus endocardial, midwall, epicardial scar; P<0.05 by ANOVA). Most ventricular tachycardia circuit sites were located in scar with >25{\%} scar transmurality. Conclusions-Electrogram features are associated with scar morphology and distribution in patients with nonischemic cardiomyopathy. Previous knowledge of electrogram image associations may optimize procedural strategies including the decision to obtain epicardial access.",
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T1 - Impact of nonischemic scar features on local ventricular electrograms and scar-related ventricular tachycardia circuits in patients with nonischemic cardiomyopathy

AU - Sasaki, Takeshi

AU - Miller, Christopher F.

AU - Hansford, Rozann

AU - Zipunnikov, Vadim

AU - Zviman, Menekhem M.

AU - Marine, Joseph E.

AU - Spragg, David

AU - Cheng, Alan

AU - Tandri, Harikrishna

AU - Sinha, Sunil

AU - Kolandaivelu, Aravindan

AU - Zimmerman, Stefan L.

AU - Bluemke, David A.

AU - Tomaselli, Gordon F.

AU - Berger, Ronald D.

AU - Halperin, Henry R.

AU - Calkins, Hugh

AU - Nazarian, Saman

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Background-The association of local electrogram features with scar morphology and distribution in nonischemic cardiomyopathy has not been investigated. We aimed to quantify the association of scar on late gadolinium-enhanced cardiac magnetic resonance with local electrograms and ventricular tachycardia circuit sites in patients with nonischemic cardiomyopathy. Methods and Results-Fifteen patients with nonischemic cardiomyopathy underwent late gadolinium-enhanced cardiac magnetic resonance before ventricular tachycardia ablation. The transmural extent and intramural types (endocardial, midwall, epicardial, patchy, transmural) of scar were measured in late gadolinium-enhanced cardiac magnetic resonance short-axis planes. Electroanatomic map points were registered to late gadolinium-enhanced cardiac magnetic resonance images. Myocardial wall thickness, scar transmurality, and intramural scar types were independently associated with electrogram amplitude, duration, and deflections in linear mixed-effects multivariable models, clustered by patient. Fractionated and isolated potentials were more likely to be observed in regions with higher scar transmurality (P<0.0001 by ANOVA) and in regions with patchy scar (versus endocardial, midwall, epicardial scar; P<0.05 by ANOVA). Most ventricular tachycardia circuit sites were located in scar with >25% scar transmurality. Conclusions-Electrogram features are associated with scar morphology and distribution in patients with nonischemic cardiomyopathy. Previous knowledge of electrogram image associations may optimize procedural strategies including the decision to obtain epicardial access.

AB - Background-The association of local electrogram features with scar morphology and distribution in nonischemic cardiomyopathy has not been investigated. We aimed to quantify the association of scar on late gadolinium-enhanced cardiac magnetic resonance with local electrograms and ventricular tachycardia circuit sites in patients with nonischemic cardiomyopathy. Methods and Results-Fifteen patients with nonischemic cardiomyopathy underwent late gadolinium-enhanced cardiac magnetic resonance before ventricular tachycardia ablation. The transmural extent and intramural types (endocardial, midwall, epicardial, patchy, transmural) of scar were measured in late gadolinium-enhanced cardiac magnetic resonance short-axis planes. Electroanatomic map points were registered to late gadolinium-enhanced cardiac magnetic resonance images. Myocardial wall thickness, scar transmurality, and intramural scar types were independently associated with electrogram amplitude, duration, and deflections in linear mixed-effects multivariable models, clustered by patient. Fractionated and isolated potentials were more likely to be observed in regions with higher scar transmurality (P<0.0001 by ANOVA) and in regions with patchy scar (versus endocardial, midwall, epicardial scar; P<0.05 by ANOVA). Most ventricular tachycardia circuit sites were located in scar with >25% scar transmurality. Conclusions-Electrogram features are associated with scar morphology and distribution in patients with nonischemic cardiomyopathy. Previous knowledge of electrogram image associations may optimize procedural strategies including the decision to obtain epicardial access.

KW - Tachycardia

KW - Ventricular

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