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Epicardial Conduction Speed, Electrogram Abnormality, and Computed Tomography Attenuation Associations in

Tuna Ustunkaya1, Benoit Desjardins2, Riley Wedan1

  • 1Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

JACC. Clinical Electrophysiology
|October 26, 2019
PubMed

Insights

Low contrast-enhanced multidetector computed tomography (CE-MDCT) attenuation in arrhythmogenic right ventricular cardiomyopathy (ARVC) correlates with slower electrical conduction and abnormal electrograms. These findings identify key ventricular tachycardia (VT) substrates for ablation.

Area of Science:

  • Cardiology
  • Radiology
  • Electrophysiology

Background:

  • Contrast-enhanced multidetector computed tomography (CE-MDCT) is a high-resolution imaging technique.
  • The relationship between CE-MDCT hypoattenuation and ventricular tachycardia (VT) substrates in arrhythmogenic right ventricular cardiomyopathy (ARVC) is not well understood.
  • CE-MDCT offers advantages over other imaging modalities due to its speed and reduced artifact susceptibility.

Purpose of the Study:

  • To investigate the association between CE-MDCT attenuation values and local epicardial conduction speed (ECS).
  • To evaluate the link between CE-MDCT attenuation and electrographic abnormalities in patients with ARVC and VT.
  • To identify potential imaging markers for VT substrates in ARVC patients undergoing ablation.

Main Methods:

  • Prospective enrollment of ARVC patients undergoing CE-MDCT, electroanatomical mapping (EAM), and VT ablation.
  • Calculation of right ventricular (RV) mid-myocardial attenuation from 3D MDCT images, registered to EAM data.
  • Determination of local ECS by averaging conduction speed between adjacent points with concordant wavefronts.

Main Results:

  • A significant association was found between RV myocardial attenuation and epicardial bipolar voltage amplitude (2.5% decrease per 10 HU decrease).
  • RV myocardial attenuation was also linked to endocardial unipolar voltage amplitude (0.9% decrease per 10 HU decrease).
  • Lower CE-MDCT attenuation correlated with reduced ECS (0.4% decrease per 10 HU decrease), indicating slower conduction.

Conclusions:

  • CE-MDCT attenuation patterns reflect regional conduction speed and electrographic abnormalities in ARVC.
  • Hypoattenuated regions in the RV likely represent fibro-fatty infiltration, a known substrate for VT.
  • CE-MDCT-derived attenuation may serve as a valuable tool for identifying VT substrates in ARVC patients undergoing ablation.
Abstract

Keywords:
arrhythmogenic right ventricular cardiomyopathyconduction speedendocardial mappingepicardial mappingmultidetector computed tomographyventricular tachycardia ablation

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