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Biventricular, endocardial, and epicardial substrate characterization for ventricular tachycardia and correlation with whole-heart macropathology and histopathology in a patient with lamin A/C cardiomyopathy.

ABSTRACT:

SUBMITTER: Bhaskaran A

PROVIDER: S-EPMC6404103 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Biventricular, endocardial, and epicardial substrate characterization for ventricular tachycardia and correlation with whole-heart macropathology and histopathology in a patient with lamin A/C cardiomyopathy.

Bhaskaran Ashwin A Bhat Aditya A Trivic Ivana I Muthiah Kavitha K Barrett Wade W Liang Sharron S Kanthan Ajita A Kumar Saurabh S

HeartRhythm case reports 20181130 3

PMID: 30891408

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Project description:AimsCatheter ablation of ventricular tachycardia (VT) improves VT-free survival in 'classic' arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aims to investigate electrophysiological features and ablation outcomes in patients with ARVC and biventricular (BiV) involvement.Methods and resultsWe assembled a retrospective cohort of definite ARVC cases with sustained VTs. Patients were divided into the BiV (BiV involvement) group and the right ventricular (RV) (isolated RV involvement) group based on the left ventricular systolic function detected by cardiac magnetic resonance. All patients underwent electrophysiological mapping and VT ablation. Acute complete success was non-inducibility of any sustained VT, and the primary endpoint was VT recurrence. Ninety-eight patients (36 ± 14 years; 87% male) were enrolled, including 50 in the BiV group and 48 in the RV group. Biventricular involvement was associated with faster clinical VTs, a higher VT inducibility, and more extensive arrhythmogenic substrates (all P < 0.05). Left-sided VTs were observed in 20% of the BiV group cases and correlated with significantly reduced left ventricular systolic function. Catheter ablation achieved similar acute efficacy between these two groups, whereas the presence of left-sided VTs increased acute ablation failure (40 vs. 5%, P = 0.012). Over 51 ± 34 months [median, 48 (22-83) months] of follow-up, cumulative VT-free survival was 52% in the BiV group and 58% in the RV group (P = 0.353). A multivariate analysis showed that younger age, lower RV ejection fraction (RVEF), and non-acute complete ablation success were associated with VT recurrence in the BiV group.ConclusionBiventricular involvement implied a worse arrhythmic phenotype and increased the risk of left-sided VTs, while catheter ablation maintained its efficacy for VT control in this population. Younger age, lower RVEF, and non-acute complete success predicted VT recurrence after ablation.

Dataset Information

Biventricular, endocardial, and epicardial substrate characterization for ventricular tachycardia and correlation with whole-heart macropathology and histopathology in a patient with lamin A/C cardiomyopathy.

Publications

Biventricular, endocardial, and epicardial substrate characterization for ventricular tachycardia and correlation with whole-heart macropathology and histopathology in a patient with lamin A/C cardiomyopathy.

Similar Datasets

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