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Quinto L, Sanchez P, Alarcón F, Garre P, Zaraket F, Prat-Gonzalez S, Ortiz-Perez JT, JesúsPerea R, Guasch E, Tolosana JM, San Antonio R, Arbelo E, Sitges M, Brugada J, Berruezo A, Mont L, Roca-Luque I. Cardiac magnetic resonance to predict recurrences after ventricular tachycardia ablation: septal involvement, transmural channels, and left ventricular mass. Europace 2021; 23:1437-1445. [PMID: 34142121 DOI: 10.1093/europace/euab127] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 05/07/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Ventricular tachycardia (VT) substrate-based ablation has an increasing role in patients with structural heart disease-related VT. VT is linked to re-entry in relation to myocardial scarring with areas of conduction block (core scar) and areas of slow conduction [border zone (BZ)]. VT substrate can be analysed by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Our study aims to analyse the role of LGE-CMR in identifying predictors of VT recurrence after ablation. METHODS AND RESULTS We analysed 110 consecutive patients who underwent VT ablation from 2013 to 2018. All patients underwent a preprocedural LGE-CMR, and in 94 patients (85.5%), the CMR was used to aid the ablation. All LGE-CMR images were semi-automatically processed using dedicated software to detect scarring and conducting channels. After a median follow-up of 2.7 ± 1.6 years, the overall VT recurrence was 41.8% with an implantable cardioverter-defibrillator shock reduction from 43.6% to 28.2% before and after ablation, respectively. The amount of BZ (26.6 ± 13.9 vs. 19.6 ± 9.7 g, P = 0.012), the total amount of scarring (37.1 ± 18.2 vs. 29 ± 16.3 g, P = 0,033), and left ventricular (LV) mass (168.3 ± 53.3 vs. 152.3 ± 46.4 g, P < 0.001) were associated with VT recurrence. LGE septal distribution [62.5% vs. 37.8%; hazard ratio (HR) 1.67 (1.02-3.93), P = 0.044], channels with transmural path [66.7% vs. 31.4%, HR 3.25 (1.70-6.23), P < 0.001], and midmural channels [54.3% vs. 27.6%, HR 2.49 (1.21-5.13), P = 0.013] were related with VT recurrence. Multivariate analysis showed that the presence of septal LGE [HR 3.67 (1.60-8.38), P = 0.002], transmural channels [HR 2.32 (1.15-4.72), P = 0.019], and LV mass [HR 1.01 (1.005-1.019), P = 0.002] were independent predictors of VT recurrence. CONCLUSION Pre-procedural LGE-CMR is a helpful and feasible technique to identify patients with high risk of VT recurrence after ablation. LV mass, septal LGE distribution, and transmural channels were predictive factors of post-ablation VT recurrence.
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Affiliation(s)
- Levio Quinto
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Paula Sanchez
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Francisco Alarcón
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Paz Garre
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Fatima Zaraket
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Susana Prat-Gonzalez
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Jose T Ortiz-Perez
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Rosario JesúsPerea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centre de Diagnòstic per la Imatge, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José Maria Tolosana
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rodolfo San Antonio
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Elena Arbelo
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marta Sitges
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Josep Brugada
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Antonio Berruezo
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Lluís Mont
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ivo Roca-Luque
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Quinto L, Sanchez-Somonte P, Alarcón F, Garre P, Castillo À, San Antonio R, Borras R, Guasch E, Arbelo E, Tolosana JM, Berruezo A, Mont L, Roca-Luque I. Ventricular tachycardia burden reduction after substrate ablation: Predictors of recurrence. Heart Rhythm 2021; 18:896-904. [PMID: 33639298 DOI: 10.1016/j.hrthm.2021.02.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Substrate-based ventricular tachycardia (VT) ablation is a first-line treatment in patients with structural cardiac disease and sustained VT refractory to medical therapy. Despite technological improvements and increased knowledge of VT substrate, recurrence still is frequent. Published data are lacking on the possible reduction in VT burden after ablation despite recurrence. OBJECTIVE The purpose of this study was to assess VT burden reduction during long-term follow-up after substrate ablation and identify predictors of VT recurrence. METHODS We analyzed 234 consecutive VT ablation procedures in 207 patients (age 63 ± 14.9 years; 92% male; ischemic heart disease in 65%) who underwent substrate ablation in a single center from 2013 to 2018. RESULTS After follow-up of 3.14 ± 1.8 years, the VT recurrence rate was 41.4%. Overall, a 99.6% reduction in VT burden (median VT episodes per year: preprocedural 3.546 [1.347-13.951] vs postprocedural 0.001 [0-0.689]; P = .001) and a 96.3% decrease in implantable cardioverter-defibrillator (ICD) shocks (preprocedural 1.145 [0.118-4.467] vs postprocedural 0.042 [0-0.111] per year; P = .017) were observed. In the subgroup of patients who experienced VT recurrences, VT burden decreased by 69.2% (median VT episodes per year: preprocedural 2.876 [1.105-8.801] vs postprocedural 0.882 [0.505-2.283]; P <.001). Multivariable analysis showed persistence of late potentials (67% vs 19%; hazard ratio 3.18 [2.18-6.65]; P <.001) and lower left ventricular ejection fraction (EF) (30 [25-40] vs 39 [30-50]; P = .022) as predictors of VT recurrence. CONCLUSION Despite a high recurrence rate during long-term follow-up, substrate-based VT ablation is related to a large reduction in VT burden and a decrease in ICD therapies. Lower EF and persistence of late potentials are predictors of recurrence.
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Affiliation(s)
- Levio Quinto
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Paula Sanchez-Somonte
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Francisco Alarcón
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Paz Garre
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Àngel Castillo
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Rodolfo San Antonio
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Roger Borras
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José Maria Tolosana
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Antonio Berruezo
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Lluís Mont
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ivo Roca-Luque
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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