Isolated critical epicardial arrhythmogenic substrate abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy and ventricular tachycardia

Tschabrunn, Cory M.; Zado, Erica S.; Schaller, Robert D.; García, Fermin C.; Kumareswaran, Ramanan; Hsue, Weihow; Marchlinski, Francis E.

doi:10.1016/j.hrthm.2021.11.035

Cited by 14 publications

(8 citation statements)

References 15 publications

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“…In early stages of ARVC in people, scar and reentry circuits are located nearly exclusively in the epicardium; it is not until more advanced stages of disease that the VT substrate reaches the endocardium 44 . Although direct epicardial mapping was not performed in our study, a recent investigation in human ARVC patients determined that detection of isolated epicardial substrate may be suggested by endocardial unipolar voltage abnormalities 45 . Specifically, areas with abnormal endocardial unipolar EGMs corresponded to abnormal epicardial bipolar voltage maps and VT circuits isolated to the epicardium, demonstrating the utility of unipolar voltage assessment as a valuable surrogate to interrogate the epicardium without direct access.…”

Section: Discussionmentioning

confidence: 84%

“…44 Although direct epicardial mapping was not performed in our study, a recent investigation in human ARVC patients determined that detection of isolated epicardial substrate may be suggested by endocardial unipolar voltage abnormalities. 45 Specifically, areas with abnormal endocardial unipolar EGMs corresponded to abnormal epicardial bipolar voltage maps and VT circuits isolated to the epicardium, demonstrating the utility of unipolar voltage assessment as a valuable surrogate to interrogate the epicardium without direct access. Although unipolar threshold values have not been established specifically in Boxers, we utilized more conservative lower thresholds than did previous studies in dogs, 28 and infer that it is unlikely that the dogs in our study with normal bipolar endocardial substrate had confluent unipolar abnormalities suggestive of an epicardial scar.…”

Section: Discussionmentioning

confidence: 89%

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Feasibility of electroanatomic mapping and radiofrequency catheter ablation in Boxer dogs with symptomatic ventricular tachycardia

Crooks

Hsue

Tschabrunn

et al. 2022

Veterinary Internal Medicne

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Background: Treatment for Boxers with ventricular tachycardia (VT) is limited. Electroanatomic mapping (EAM) facilitates identification of arrhythmogenic substrate for radiofrequency catheter ablation (RFCA).Objective: Describe the use of EAM to guide RFCA in Boxers with VT.Animals: Five client-owned Boxers with symptomatic VT or persistent VT despite antiarrhythmic medications.Methods: Case series evaluating clinical, EAM, and before and after RFCA Holter data.Results: Sustained VT was inducible in 3 dogs, but required aggressive stimulation protocols. Low-voltage areas consistent with electroanatomic scar were found in 2 dogs, located at the right ventricular (RV) outflow tract and cranial RV. Two dogs had a focal activation pattern of VT and 1 dog had a reentrant mechanism. After RFCA, all dogs no longer collapsed and had fewer runs of VT, 3 of which had 0 runs of VT. Number of ventricular premature beats increased in 3 dogs and decreased in 2 dogs, 1 of which had nearly complete resolution of all arrhythmias. Procedural complications included ventricular fibrillation (n = 2) with successful defibrillation, bruising or hemorrhage at the vascular access site (n = 4), retroperitoneal hemorrhage (n = 1), aortic and mitral regurgitation (n = 1), onset of frequent supraventricular tachycardia (n = 1), and persistent right pelvic limb lameness (n = 1).Conclusions and Clinical Importance: Electroanatomic mapping and RFCA are feasible in Boxers with VT. Based on this small cohort, RFCA may help decrease runs of Abbreviations: %VE, percent of total ventricular beats consisting of ventricular premature complexes; AAD, antiarrhythmic drug; ARVC, arrhythmogenic right ventricular cardiomyopathy; EAM, electroanatomic mapping; EGM, electrogram; LBBB, left bundle branch block; LV, left ventricle; OTVT, outflow tract ventricular tachycardia; PES, programmed electrical stimulation; RBBB, right bundle branch block; RFCA, radiofrequency catheter ablation; RV, right ventricle; RVOT, right ventricular outflow tract; VA, ventricular arrhythmia; VE, ventricular ectopy; VPC, ventricular premature complex; VT, ventricular tachycardia. Alexandra V. Crooks and Weihow Hsue are co-first authors.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 89%

Feasibility of electroanatomic mapping and radiofrequency catheter ablation in Boxer dogs with symptomatic ventricular tachycardia

Crooks

Hsue

Tschabrunn

et al. 2022

Veterinary Internal Medicne

Self Cite

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“… 11 It is important to note that CMR has been reported to be less sensitive than endocardial voltage mapping in identifying RV scar. 12 , 13 The lack of delayed gadolinium enhancement in our patient may be explained by an early or mild form of ARVC with microscopic injury or thin layer of fibrosis that may not reach the threshold of CMR resolution. It also remains unclear if high-definition mapping may lead to greater discordance in CMR and voltage mapping findings.…”

Section: Discussionmentioning

confidence: 77%

Exercise-induced arrhythmogenic right ventricular cardiomyopathy: Reverse remodeling with detraining

Darden¹,

Scheinman²,

Hoffmayer³

2022

HeartRhythm Case Reports

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“…Low voltage areas and fragmented electrograms detected by electroanatomic mapping have been reported as common findings in ARVC patients that can enhance the diagnosis [ 18 , 29 , 30 , 33 ]. Low-voltage areas, recorded from both the endocardium and epicardium, and RV endocardial activation delay have been reported as sensitive markers that can distinguish of ARVC from benign RVOT ventricular tachycardia [ 5 , 34 , 35 ]. Although an electrophysiologic procedure with electroanatomic mapping could be useful for diagnostic purposes its invasive nature and potential risk for complications makes it less suitable for serial evaluations.…”

Section: Discussionmentioning

confidence: 99%

Epicardial conduction abnormalities in patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) and mutation positive healthy family members – A study using electrocardiographic imaging

2023

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Background The diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) in early stages is challenging. The aim of this study was therefore to investigate whether electrocardiographic imaging (ECGI) can detect epicardial conduction changes in ARVC patients and healthy mutation-carriers (M-carriers). Method Twelve ARVC patients, 20 M-carriers and 8 controls underwent 12-lead ECG, signal-averaged ECG, 2-dimensional echocardiography, 24-hours Holter monitoring and ECGI (body surface mapping and computer tomography with offline analysis of reconstructed epicardial signals). Total and Right Ventricular Activation Time (tVAT and RVAT respectively), area of Ventricular Activation during the terminal 20 milliseconds (aVAte20) and the activation patterns were compared between groups. Results In ARVC patients the locations of aVAte20 were scattered or limited to smaller parts of the right ventricle (RV) versus in controls, in whom aVAte20 was confined to right ventricular outflow tract (RVOT) and left ventricle (LV) base (+/- RV base). ARVC patients had smaller aVAte20 (35cm2 vs 87cm2, p<0.05), longer tVAT (99msec vs 58msec, p<0.05) and longer RVAT (66msec vs 43msec, p<0.05) versus controls. In 10 M-carriers (50%), the locations of aVAte20 were also eccentric. This sub-group presented smaller aVAte20 (53cm2 vs 87cm2, p = 0.009), longer RVAT (55msec vs 48msec, p = 0.043), but similar tVAT (65msec vs 60msec, p = 0.529) compared with the M-carriers with normal activation pattern. Conclusions ECGI can detect epicardial conduction abnormalities in ARVC patients. Moreover, the observation of localized delayed RV epicardial conduction in M-carriers suggests an early stage of ARVC and may be a useful diagnostic marker enhancing an early detection of the disease.

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Isolated critical epicardial arrhythmogenic substrate abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy and ventricular tachycardia

Cited by 14 publications

References 15 publications

Feasibility of electroanatomic mapping and radiofrequency catheter ablation in Boxer dogs with symptomatic ventricular tachycardia

Feasibility of electroanatomic mapping and radiofrequency catheter ablation in Boxer dogs with symptomatic ventricular tachycardia

Exercise-induced arrhythmogenic right ventricular cardiomyopathy: Reverse remodeling with detraining

Epicardial conduction abnormalities in patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) and mutation positive healthy family members – A study using electrocardiographic imaging

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