CMR–Based Identification of Critical Isthmus Sites of Ischemic and Nonischemic Ventricular Tachycardia

Piers, Sebastiaan R.D.; Tao, Qian; Silva, Marta de Riva; Siebelink, Hans-Marc; Schalij, Martin J.; Geest, Rob J. van der; Zeppenfeld, Katja

doi:10.1016/j.jcmg.2014.03.013

Cited by 106 publications

(73 citation statements)

References 14 publications

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“…This is in line with our prior findings during VT ablation procedures, demonstrating that the critical VT isthmus sites are typically located close to the core-border zone transition (i.e., the 50% of maximal signal intensity cut-off value) and to >75% transmural scar. 17 These more specific LGE features may facilitate identification of NIDCM patients at risk for monomorphic VT.…”

Section: Myocardial Scar and Type Of Ventricular Arrhythmiamentioning

confidence: 99%

Myocardial scar predicts monomorphic ventricular tachycardia but not polymorphic ventricular tachycardia or ventricular fibrillation in nonischemic dilated cardiomyopathy

et al. 2015

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Section: Myocardial Scar and Type Of Ventricular Arrhythmiamentioning

confidence: 99%

Myocardial scar predicts monomorphic ventricular tachycardia but not polymorphic ventricular tachycardia or ventricular fibrillation in nonischemic dilated cardiomyopathy

et al. 2015

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“…34 Subsequent patient studies also suggest the close proximity of critical VT isthmus sites to the core-gray transition zone and CMR-derived tissue characterization not only correlates with but improves upon the EAVM identification of VT ablation targets. 35, 36 Other recent studies have used segmented myocardial shells to delineate layers of core as distinct from border zones and thereby locate border zone channels that correlate with VT isthmuses identified by electroanatomic pacemapping. 37, 38 …”

Section: Cmr Assessment Of Myocardial Scar and Scar Heterogeneitymentioning

confidence: 99%

Sudden Cardiac Death Substrate Imaged by Magnetic Resonance Imaging

2017

Circ: Cardiovascular Imaging

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Sudden cardiac death (SCD) is a devastating event afflicting 350,000 Americans annually, despite the availability of life-saving preventive therapy, the implantable cardioverter defibrillator (ICD). SCD prevention strategies are hampered by overreliance on global left ventricular ejection fraction (LVEF) below 35% as the most important criterion to determine ICD candidacy. Annually in the U.S. alone, this results in approximately 130,000 ICD placements at a cost of over $3 billion but only a 5% incidence per year of appropriate firings. This approach further fails to identify individuals who experience the majority, as many as 80%, of SCD events, which occur in the setting of more preserved LVEF. Better risk stratification is needed to improve care and should be guided by direct pathophysiologic markers of arrhythmic substrate, such as specific LV structural abnormalities. There is an increasing body of literature to support the prognostic value of cardiac magnetic resonance imaging with late gadolinium enhancement (CMR-LGE) in phenotyping the LV to identify those at highest risk for SCD. CMR has unparalleled tissue characterization ability and provides exquisite detail about myocardial structure and composition, abnormalities of which form the direct, pathophysiologic substrate for SCD. Here we review the evolution and current state of CMR for imaging the arrhythmic substrate, both as a research tool and for clinical applications.

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“…Piers et al . 21 described the characteristics of critical isthmus sites in 44 patients with ischemic cardiomyopathy and NICM undergoing VT ablation with pre-procedural CMR. The authors found the critical VT isthmus sites to be in close proximity to areas of higher (>75%) scar transmurality and scar border zones as noted in CMR.…”

Section: Update On Diagnostic and Non-invasive Imaging Modalitiesmentioning

confidence: 99%

Recent advances in the management of ventricular tachyarrhythmias

et al. 2017

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Ventricular arrhythmias are an important cause of cardiovascular morbidity and mortality, particularly in those with structural heart disease, inherited cardiomyopathies, and channelopathies. The goals of ventricular arrhythmia management include symptom relief, improving quality of life, reducing implantable cardioverter defibrillator shocks, preventing deterioration of left ventricular function, reducing risk of arrhythmic death, and potentially improving overall survival. Guideline-directed medical therapy and implantable cardioverter defibrillator implantation remain the mainstay of therapy to prevent sudden cardiac death in patients with ventricular arrhythmias in the setting of structural heart disease. Recent advances in imaging modalities and commercial availability of genetic testing panels have enhanced our mechanistic understanding of the disease processes and, along with significant progress in catheter-based ablative therapies, have enabled a tailored and more effective management of drug-refractory ventricular arrhythmias. Several gaps in our knowledge remain and require further research. In this article, we review the recent advances in the diagnosis and management of ventricular arrhythmias.

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CMR–Based Identification of Critical Isthmus Sites of Ischemic and Nonischemic Ventricular Tachycardia

Abstract: Both in ischemic and nonischemic VT, critical isthmus sites are typically located in close proximity to the CMR-derived core-BZ transition and to >75% transmural scar. These findings suggest that CMR-derived scar characteristics may guide to critical isthmus sites during VT ablation.

Cited by 106 publications

References 14 publications

Myocardial scar predicts monomorphic ventricular tachycardia but not polymorphic ventricular tachycardia or ventricular fibrillation in nonischemic dilated cardiomyopathy

Myocardial scar predicts monomorphic ventricular tachycardia but not polymorphic ventricular tachycardia or ventricular fibrillation in nonischemic dilated cardiomyopathy

Sudden Cardiac Death Substrate Imaged by Magnetic Resonance Imaging

Recent advances in the management of ventricular tachyarrhythmias

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