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Ventricular Arrhythmia Substrate Distribution and Its Relation to Sympathetic Innervation in Nonischemic

H Sophia Chen1, Christiane Jungen2, Yoshitaka Kimura3

  • 1Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands.

JACC. Clinical Electrophysiology
|October 20, 2022
PubMed

Insights

In nonischemic cardiomyopathy patients, sympathetic denervation is linked to fibrosis. A mismatch in anteroseptal scar (ASS) and innervation may explain why these ventricular arrhythmias (VAs) are harder to treat with ablation.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Imaging

Background:

  • Nonischemic cardiomyopathy (NICM) patients undergoing ventricular arrhythmia (VA) ablation often have inferolateral (ILS) or anteroseptal (ASS) substrates.
  • ASS substrates are associated with poorer ablation outcomes.
  • The relationship between sympathetic denervation, fibrosis, and different VA substrates in NICM is not well understood.

Purpose of the Study:

  • To investigate the association between VA substrates, myocardial fibrosis, and sympathetic denervation in NICM patients.
  • To compare the distribution of fibrosis and sympathetic denervation in ILS versus ASS substrates.

Main Methods:

  • Thirty-five NICM patients from the Leiden NICM Study (2011-2018) were analyzed.
  • Electroanatomic voltage mapping and iodine-123 metaiodobenzylguanidine imaging were performed.
  • Late gadolinium-enhanced cardiac MRI data were used to assess fibrosis; unipolar voltage (UV) served as a surrogate for diffuse fibrosis.

Main Results:

  • Global sympathetic denervation correlated significantly with diffuse myocardial fibrosis (R=0.53, P=0.02).
  • Inferolateral substrates (ILS) showed concordant low UV, sympathetic denervation, and scar.
  • Anteroseptal substrates (ASS) showed low UV and scar in most patients, but sympathetic denervation was present in only 27% (P=0.0002).

Conclusions:

  • Global sympathetic denervation is associated with fibrosis in NICM patients with VA.
  • A regional mismatch between fibrosis and preserved sympathetic innervation in ASS substrates may contribute to ablation resistance.
  • Targeting sympathetic denervation could be a future strategy for managing difficult-to-ablate VAs in NICM.
Abstract

Keywords:
arrhythmogenicityautonomic nervous systemdilated cardiomyopathyelectroanatomic voltage mappingsympathetic denervationventricular tachycardia

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