Center for Arrhythmia Care, University of Chicago Medicine, Pritzker School of Medicine, Chicago, Illinois.
Cardiac Imaging Center, University of Chicago Medicine, Pritzker School of Medicine, Chicago, Illinois.
Heart Rhythm. 2021 Apr;18(4):579-588. doi: 10.1016/j.hrthm.2020.12.003. Epub 2020 Dec 8.
Ventricular tachycardia (VT) from the anteroseptal subtype of nonischemic cardiomyopathy has a high probability of recurrence after catheter ablation.
The purpose of this study was to determine the predictive value of septal scar patterns by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) on ablation outcomes in patients with VT arising from an anteroseptal substrate.
Patients with periaortic VT arising from an anteroseptal substrate with preprocedural wideband LGE-CMR were divided into 2 groups by the degree of longitudinal septal LGE extension as full-length septal (≥80% anteroposterior length) or partial septal (<80% anteroposterior length). Septal LGE volumes were quantified in those with and without VT recurrence.
Among 234 patients referred for scar-related VT ablation between 2017 and 2020, 25 patients (92% male; age 64 ± 8 years) and a total of 108 VTs were analyzed. A greater number of VT morphologies were induced in patients with full-length septal LGE compared to partial septal LGE (median [interquartile range]: 5 [3-9] vs 2 [1-4]; P = .005). Patients with VT recurrence had larger septal LGE volumes compared to those without recurrence (11.4 mL [8.8-13.9] vs 4.2 mL [0-9.5]; P = .012). At median follow-up of 16 months (5-22), overall freedom from VT recurrence was 52% and significantly higher in patients with partial septal LGE than in those with full-length septal LGE (80% vs 20%; P = .005).
VT originating from an anteroseptal substrate is associated with heterogeneous patterns and extent of CMR septal scar. Preprocedural imaging may substratify this challenging patient population for the propensity for multiple induced VT morphologies and recurrence after catheter ablation.
非缺血性心肌病所致间隔前壁型室性心动过速（VT）经导管消融后复发的可能性较高。
本研究旨在通过心脏磁共振（CMR）延迟钆增强（LGE）确定 VT 起源于间隔前壁基质患者消融结果的预测价值。
对 2017 年至 2020 年期间因主动脉周围 VT 起源于间隔前壁并进行宽频 LGE-CMR 术前检查的患者，根据纵向间隔 LGE 延伸程度将其分为全长间隔（≥80%前后长度）或部分间隔（<80%前后长度）。在有或无 VT 复发的患者中量化间隔 LGE 体积。
在 2017 年至 2020 年间因瘢痕相关 VT 消融而转诊的 234 例患者中，分析了 25 例患者（92%为男性；年龄 64±8 岁）和总共 108 例 VT。与部分间隔 LGE 相比，全长间隔 LGE 的患者诱导的 VT 形态更多（中位数[四分位数范围]：5[3-9]比 2[1-4]；P=0.005）。与无复发患者相比，VT 复发患者的间隔 LGE 体积更大（11.4 mL[8.8-13.9]比 4.2 mL[0-9.5]；P=0.012）。在中位数为 16 个月（5-22）的随访中，VT 无复发的总体率为 52%，部分间隔 LGE 患者明显高于全长间隔 LGE 患者（80%比 20%；P=0.005）。
起源于间隔前壁基质的 VT 与 CMR 间隔瘢痕的异质性模式和程度相关。术前成像可以对这一具有挑战性的患者群体进行亚分层，预测多种诱导的 VT 形态和导管消融后的复发倾向。
