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Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
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Prior myocarditis and ventricular arrhythmias: The importance of scar pattern

Michela Casella1, Marco Bergonti2, Maria Lucia Narducci3

  • 1Centro Cardiologico Monzino, IRCCS, Milano, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Ancona, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy.

Heart Rhythm
|December 21, 2020
PubMed

Insights

Anteroseptal scar in patients with prior myocarditis predicts worse outcomes for ventricular arrhythmias, regardless of treatment. This scar pattern impacts the effectiveness of catheter ablation for these patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Imaging

Background:

  • Anteroseptal scar significance is established in nonischemic cardiomyopathy.
  • Limited evaluation exists for anteroseptal scar in prior myocarditis patients.

Purpose of the Study:

  • Assess anteroseptal scar association with outcomes in prior myocarditis.
  • Determine scar impact on catheter ablation efficacy.

Main Methods:

  • Retrospective analysis of 144 prior myocarditis patients with arrhythmias.
  • Cardiac MRI and electroanatomic mapping for scar identification.
  • Comparison of outcomes between catheter ablation and antiarrhythmic drug therapy.

Main Results:

  • Anteroseptal scar present in 44% of patients.
  • Catheter ablation reduced antiarrhythmic drug use.
  • Anteroseptal scar independently predicted ventricular arrhythmia relapse (HR 2.0, P=.02).

Conclusions:

  • Anteroseptal scar presence is a negative predictor of outcomes in prior myocarditis with ventricular arrhythmias.
  • Scar's negative impact persists regardless of treatment strategy.
Abstract

Keywords:
Anteroseptal scarCardiac magnetic resonanceCatheter ablationElectroanatomic voltage mappingPrior myocarditisVentricular arrhythmia

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