Myocardial structural associations with local electrograms

A study of postinfarct ventricular tachycardia pathophysiology and magnetic resonance-based noninvasive mapping

Takeshi Sasaki, Christopher F. Miller, Rozann Hansford, Juemin Yang, Brian S. Caffo, Menekhem M. Zviman, Charles A. Henrikson, 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, Hugh Calkins, Henry R. Halperin, Saman Nazarian

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background: The association of scar on late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) with local electrograms on electroanatomic mapping has been investigated. We aimed to quantify these associations to gain insights regarding LGE-CMR image characteristics of tissues and critical sites that support postinfarct ventricular tachycardia (VT). Methods and Results: LGE-CMR was performed in 23 patients with ischemic cardiomyopathy before VT ablation. Left ventricular wall thickness and postinfarct scar thickness were measured in each of 20 sectors per LGE-CMR short-axis plane. Electroanatomic mapping points were retrospectively registered to the corresponding LGE-CMR images. Multivariable regression analysis, clustered by patient, revealed significant associations among left ventricular wall thickness, postinfarct scar thickness, and intramural scar location on LGE-CMR, and local endocardial electrogram bipolar/unipolar voltage, duration, and deflections on electroanatomic mapping. Anteroposterior and septal/lateral scar localization was also associated with bipolar and unipolar voltage. Antiarrhythmic drug use was associated with electrogram duration. Critical sites of postinfarct VT were associated with >25% scar transmurality, and slow conduction sites with >40 ms stimulus-QRS time were associated with >75% scar transmurality. Conclusions: Critical sites for maintenance of postinfarct VT are confined to areas with >25% scar transmurality. Our data provide insights into the structural substrates for delayed conduction and VT and may reduce procedural time devoted to substrate mapping, overcome limitations of invasive mapping because of sampling density, and enhance magnetic resonance-based ablation by feature extraction from complex images.

Original languageEnglish (US)
Pages (from-to)1081-1090
Number of pages10
JournalCirculation: Arrhythmia and Electrophysiology
Volume5
Issue number6
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

Fingerprint

Ventricular Tachycardia
Cicatrix
Gadolinium
Magnetic Resonance Spectroscopy
Anti-Arrhythmia Agents
Cardiomyopathies
Regression Analysis
Maintenance

Keywords

  • Ischemic heart disease
  • Late gadolinium enhancement
  • Magnetic resonance imaging
  • Mapping
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Myocardial structural associations with local electrograms : A study of postinfarct ventricular tachycardia pathophysiology and magnetic resonance-based noninvasive mapping. / Sasaki, Takeshi; Miller, Christopher F.; Hansford, Rozann; Yang, Juemin; Caffo, Brian S.; Zviman, Menekhem M.; Henrikson, Charles A.; 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.; Calkins, Hugh; Halperin, Henry R.; Nazarian, Saman.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 5, No. 6, 01.12.2012, p. 1081-1090.

Research output: Contribution to journalArticle

Sasaki, T, Miller, CF, Hansford, R, Yang, J, Caffo, BS, Zviman, MM, Henrikson, CA, Marine, JE, Spragg, D, Cheng, A, Tandri, H, Sinha, S, Kolandaivelu, A, Zimmerman, SL, Bluemke, DA, Tomaselli, GF, Berger, RD, Calkins, H, Halperin, HR & Nazarian, S 2012, 'Myocardial structural associations with local electrograms: A study of postinfarct ventricular tachycardia pathophysiology and magnetic resonance-based noninvasive mapping', Circulation: Arrhythmia and Electrophysiology, vol. 5, no. 6, pp. 1081-1090. https://doi.org/10.1161/CIRCEP.112.970699
Sasaki, Takeshi ; Miller, Christopher F. ; Hansford, Rozann ; Yang, Juemin ; Caffo, Brian S. ; Zviman, Menekhem M. ; Henrikson, Charles A. ; 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. ; Calkins, Hugh ; Halperin, Henry R. ; Nazarian, Saman. / Myocardial structural associations with local electrograms : A study of postinfarct ventricular tachycardia pathophysiology and magnetic resonance-based noninvasive mapping. In: Circulation: Arrhythmia and Electrophysiology. 2012 ; Vol. 5, No. 6. pp. 1081-1090.
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AU - Hansford, Rozann

AU - Yang, Juemin

AU - Caffo, Brian S.

AU - Zviman, Menekhem M.

AU - Henrikson, Charles A.

AU - Marine, Joseph E.

AU - Spragg, David

AU - Cheng, Alan

AU - Tandri, Harikrishna

AU - Sinha, Sunil

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AU - Zimmerman, Stefan L.

AU - Bluemke, David A.

AU - Tomaselli, Gordon F.

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AU - Nazarian, Saman

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KW - Ischemic heart disease

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