PMID- 28236155
OWN - NLM
STAT- MEDLINE
DCOM- 20180220
LR  - 20191210
IS  - 1572-8595 (Electronic)
IS  - 1383-875X (Linking)
VI  - 49
IP  - 1
DP  - 2017 Jun
TI  - Cardiac magnetic resonance imaging and electroanatomic voltage discordance in 
      non-ischemic left ventricle ventricular tachycardia and premature ventricular 
      depolarizations.
PG  - 11-19
LID - 10.1007/s10840-017-0228-8 [doi]
AB  - PURPOSE: Magnetic resonance imaging (MRI) with late gadolinium enhancement is 
      commonly performed in patients with non-ischemic LV ventricular 
      tachycardia/ventricular premature depolarizations (non-ischemic LV-VT/VPDs) to 
      define VT substrate prior to catheter ablation. We investigated the prevalence of 
      abnormal voltage and VT localized to areas of the myocardium not reported to have 
      late gadolinium enhancement (LGE) on routine pre-procedural MRI and sought to 
      determine if quantitative MRI analysis could reduce this discordance. METHODS: 
      Patients with non-ischemic LV-VT/VPD who underwent LV endocardial mapping with 
      VT/VPD ablation and either septal or free wall MRI-voltage discordance were 
      studied. Electroanatomic maps were analyzed post-procedure for areas of 
      electrogram-defined scar and VT localized to areas without reported LGE. 
      Discordant segments were then analyzed offline using delayed signal intensity of 
      >2 and >5 standard deviations above normal myocardium. RESULTS: Of 90 consecutive 
      patients, 32 (36%) patients with septal (n = 16), free wall (n = 14) or both 
      (n = 2) MRI-voltage + mismatch were identified. All discordant segments 
      demonstrated unipolar voltage abnormalities with 12 patients (6 septal and 6 free 
      wall) also showing low bipolar voltage but no LGE at signal intensity >5 standard 
      deviations. Eleven patients (5 septum, 6 free wall) had VT localized to 
      discordant areas. Ninety-three percent of patients in the septal group (26/48 
      segments) and 89% of patients in the free wall group (9/13 segments) had a 
      concordant response established by using a signal intensity cutoff of >2 standard 
      deviations. CONCLUSIONS: MRI-voltage discordance was identified in 36% of 
      patients with non-ischemic LV-VT/VPD who underwent VT ablation. In 12% of 
      patients, VT was targeted in areas of abnormal voltage not suggested by routine 
      qualitative MRI. Quantitative MRI analysis using a lower signal intensity 
      threshold increased the sensitivity for detecting areas of clinically relevant VT 
      substrate.
FAU - Betensky, Brian P
AU  - Betensky BP
AD  - Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, 
      3400 Spruce Street, Founders 9, Philadelphia, PA, 19104, USA.
FAU - Dong, Wei
AU  - Dong W
AD  - Cardiovascular Division, Hospital of the University of Pennsylvania, 
      Philadelphia, PA, USA.
AD  - Department of Cardiology, PLA General Hospital, Beijing, China.
FAU - D'Souza, Benjamin A
AU  - D'Souza BA
AD  - Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, 
      3400 Spruce Street, Founders 9, Philadelphia, PA, 19104, USA.
FAU - Zado, Erica S
AU  - Zado ES
AD  - Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, 
      3400 Spruce Street, Founders 9, Philadelphia, PA, 19104, USA.
FAU - Han, Yuchi
AU  - Han Y
AD  - Cardiovascular Division, Hospital of the University of Pennsylvania, 
      Philadelphia, PA, USA.
FAU - Marchlinski, Francis E
AU  - Marchlinski FE
AD  - Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, 
      3400 Spruce Street, Founders 9, Philadelphia, PA, 19104, USA. 
      francis.marchlinski@uphs.upenn.edu.
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
DEP - 20170224
PL  - Netherlands
TA  - J Interv Card Electrophysiol
JT  - Journal of interventional cardiac electrophysiology : an international journal of 
      arrhythmias and pacing
JID - 9708966
SB  - IM
MH  - Body Surface Potential Mapping/*methods
MH  - Cardiac Imaging Techniques/*methods
MH  - Female
MH  - Heart Ventricles/*diagnostic imaging
MH  - Humans
MH  - Magnetic Resonance Imaging, Cine/*methods
MH  - Male
MH  - Middle Aged
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Tachycardia, Ventricular/*diagnosis
MH  - Ventricular Premature Complexes/*diagnosis
OTO - NOTNLM
OT  - Ablation
OT  - Late gadolinium enhancement
OT  - MRI
OT  - Non-ischemic LV ventricular tachycardia/ventricular premature depolarizations
OT  - Ventricular tachycardia
EDAT- 2017/02/27 06:00
MHDA- 2018/02/21 06:00
CRDT- 2017/02/26 06:00
PHST- 2016/07/05 00:00 [received]
PHST- 2017/01/24 00:00 [accepted]
PHST- 2017/02/27 06:00 [pubmed]
PHST- 2018/02/21 06:00 [medline]
PHST- 2017/02/26 06:00 [entrez]
AID - 10.1007/s10840-017-0228-8 [pii]
AID - 10.1007/s10840-017-0228-8 [doi]
PST - ppublish
SO  - J Interv Card Electrophysiol. 2017 Jun;49(1):11-19. doi: 
      10.1007/s10840-017-0228-8. Epub 2017 Feb 24.