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• W4377012783 abstract "The dominant mechanism of ventricular tachycardia (VT) in patients with non-ischemic cardiomyopathy (NICM) is re-entry related to fibrosis. Fibrosis does not equal VT substrate. Describe histological characteristics associated with VT substrate in NICM using electroanatomical mapping (EAM) data and whole human heart histology 10 patients with NICM who died or underwent heart transplantation after catheter ablation (CA) for VT were included. VT related sites were categorized as class I (entrainment response/VT termination during CA), or class II (other ablation target sites). Explanted hearts were sliced and stained. Ablation lesions were identified and excluded. EAM and whole heart histology were integrated and class I/II sites projected onto the slices using reversed registration and assigned to a segment (32 segment model). VT exit sites (based on 12 lead VT-ECG) were indicated on a 16-segment model. The amount and homogeneity of fibrosis was determined. A new measure of inhomogeneity was developed with scores between 0 (inhomogeneous confluent) and 0.5 (homogeneous diffuse). In 10 patients a median of 11 (range 3-18) VTs were induced. A total of 37 class I sites were identified and 182/320 segments contained class II sites (figure). The LV had a median of 24.7% fibrosis (range 11.3-39.3%). More fibrosis was found in the basal anteroseptum which also contained the majority of class 1 (21/37) sites. In contrast, VT exit areas were clustered in the apico-septal and basal anterolateral segments. Class 1 VT related site segments had more fibrosis (median 35.3% IQR[29.1-48.7] vs 22.1%[13.2-32.8], p<0.001) and were more inhomogeneous confluent (median 0.22 IQR [0.185-0.257] vs 0.27[0.217-0.312], p=0.003) compared to segments without class 1 sites. These findings were true for class 2 sites (p<0.004). ROC analysis found a cut-off of >31% fibrosis for the identification of class I VT related sites (AUC:0.75, sens.72%, spec.72%). In segments with <31% fibrosis and class 1 VT related sites, there was a tendency towards inhomogeneous confluent fibrosis compared to those without VT related sites (score 0.27 vs 0.29). In NICM hearts with VT, fibrosis clusters in the basal anteroseptum. Most VT related sites are found in segments with >31% fibrosis and more inhomogeneity but they are also found in segments with less fibrosis, but with inhomogeneous confluent fibrosis suggesting that location, amount and inhomogeneous confluence of fibrosis contribute to arrhythmogeneity." @default.
• W4377012783 created "2023-05-19" @default.
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• W4377012783 date "2023-05-01" @default.
• W4377012783 modified "2023-09-23" @default.
• W4377012783 title "PO-05-032 INTEGRATION OF ELECTROANATOMICAL MAPPING DATA WITH WHOLE HUMAN HEART HISTOLOGY TO IDENTIFY THE MORPHOLOGICAL CHARACTERISTICS OF VT SUBSTRATE IN PATIENTS WITH NICM" @default.
• W4377012783 doi "https://doi.org/10.1016/j.hrthm.2023.03.1318" @default.
• W4377012783 hasPublicationYear "2023" @default.
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