AIMS: This study aimed to analyze the influence of scar distribution between the endocardium and the epicardium in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). METHODS: Electroanatomical mapping data were derived from our ARVD/C registry. Myocardial voltage distribution between the endocardium and the epicardium was analyzed in 28 patients (18 men, 49.9 ± 13.0 years) with previous ventricular tachycardia (VT) ablation and complete right ventricular maps. RESULTS: During the follow-up period of 28 ± 22 months after ablation, 18 of 28 patients (64.3%) remained free from VT recurrence. In univariate analysis, five variables associated with VT recurrence, i. e., advanced age, right ventricular (RV) myocardial voltage ratio ≥0.58, inducibility of VT after ablation, and longer procedure and fluoroscopy time. In binary logistic regression analysis only RV myocardial voltage ratio ≥0.58 (hazard ratio 11.667, 95% confidence interval 1.487-91.543, p = 0.012) remained associated with an increased risk of VT recurrence. CONCLUSION: The myocardial voltage ratio (bipolar low voltage area/unipolar low voltage area) as a potential surrogate parameter for scar distribution between the endocardium and the epicardium is significantly associated with the outcome after VT ablation in ARVD/C.
AIMS: This study aimed to analyze the influence of scar distribution between the endocardium and the epicardium in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). METHODS: Electroanatomical mapping data were derived from our ARVD/C registry. Myocardial voltage distribution between the endocardium and the epicardium was analyzed in 28 patients (18 men, 49.9 ± 13.0 years) with previous ventricular tachycardia (VT) ablation and complete right ventricular maps. RESULTS: During the follow-up period of 28 ± 22 months after ablation, 18 of 28 patients (64.3%) remained free from VT recurrence. In univariate analysis, five variables associated with VT recurrence, i. e., advanced age, right ventricular (RV) myocardial voltage ratio ≥0.58, inducibility of VT after ablation, and longer procedure and fluoroscopy time. In binary logistic regression analysis only RV myocardial voltage ratio ≥0.58 (hazard ratio 11.667, 95% confidence interval 1.487-91.543, p = 0.012) remained associated with an increased risk of VT recurrence. CONCLUSION: The myocardial voltage ratio (bipolar low voltage area/unipolar low voltage area) as a potential surrogate parameter for scar distribution between the endocardium and the epicardium is significantly associated with the outcome after VT ablation in ARVD/C.
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Authors: Pasquale Santangeli; Erica S Zado; Gregory E Supple; Haris M Haqqani; Fermin C Garcia; Cory M Tschabrunn; David J Callans; David Lin; Sanjay Dixit; Mathew D Hutchinson; Michael P Riley; Francis E Marchlinski Journal: Circ Arrhythm Electrophysiol Date: 2015-11-06