Assessing epicardial substrate using intracardiac echocardiography during VT ablation
Rupa Bala1, Jian-Fang Ren, Mathew D Hutchinson
1Cardiovascular Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. balar@uphs.upenn.edu
Circulation. Arrhythmia and Electrophysiology
|September 2, 2011
Summary
Intracardiac echocardiography (ICE) can identify abnormal epicardial substrate in patients with nonischemic cardiomyopathy (NICM) and ventricular tachycardia (VT). This imaging technique may aid in defining VT origins in NICM patients.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Intracardiac echocardiography (ICE) has had a limited role in defining ventricular tachycardia (VT) substrates.
- Nonischemic cardiomyopathy (NICM) presents challenges in identifying VT-generating epicardial abnormalities.
Purpose of the Study:
- To assess the utility of ICE in identifying abnormal epicardial substrate in patients with NICM and VT.
- To determine if ICE findings correlate with electroanatomic mapping results.
Main Methods:
- Eighteen patients with NICM and recurrent VT underwent ICE imaging and detailed left ventricular (LV) endocardial and epicardial electroanatomic mapping.
- Low-voltage areas (<1.0 mV) in the epicardium were analyzed.
- ICE imaging findings were compared to a control group of 30 patients with normal hearts.
Main Results:
- ICE identified increased echogenicity in the lateral LV in all 18 NICM patients.
- Epicardial mapping revealed low-voltage areas and abnormal electrograms in all patients, correlating with ICE findings.
- No increased echogenicity was observed in the control group.
Conclusions:
- ICE imaging successfully identified increased echogenicity corresponding to abnormal epicardial substrate in NICM patients.
- These findings suggest ICE is a potentially valuable tool for identifying epicardial VT substrate in NICM.
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