PMID- 30089553 OWN - NLM STAT- MEDLINE DCOM- 20191023 LR - 20191023 IS - 2405-5018 (Electronic) IS - 2405-500X (Linking) VI - 4 IP - 3 DP - 2018 Mar TI - Characterization of the Electroanatomic Substrate in Cardiac Sarcoidosis: Correlation With Imaging Findings of Scar and Inflammation. PG - 291-303 LID - S2405-500X(17)30943-X [pii] LID - 10.1016/j.jacep.2017.09.175 [doi] AB - OBJECTIVES: This study sought to characterize the electroanatomic (EAM) substrate in patients with cardiac sarcoidosis (CS) and ventricular tachycardia and its relationship to imaging findings of inflammation and fibrosis. BACKGROUND: CS is characterized by coexistence of active inflammation and replacement fibrosis. METHODS: A total of 42 patients with CS based on established criteria and ventricular tachycardia underwent high-density EAM mapping. Abnormal electrograms (EGM) were collected and independently classified as multicomponent fractionated, isolated, late, and split according to standard criteria and regardless of the peak-to-peak bipolar/unipolar voltage. A total of 29 patients (69%) underwent pre-procedural cardiac magnetic resonance (CMR) and positron emission tomography (PET)/computed tomography (CT). The distribution of EAM substrate was correlated with regions of late gadolinium enhancement (LGE) on CMR and increased 18F-fluorodeoxyglucose uptake on PET/CT. RESULTS: Of 21,451 bipolar and unipolar EGM, 4,073 (19%) were classified as abnormal with a predominant distribution in the basal perivalvular segments and interventricular septum. Using the standard bipolar (<1.5 mV) and unipolar (<8.3 mV for left ventricle <5.5 mV for the right) voltage cutoff values, 40% and 22% of the abnormal EGM were located outside the EAM low-voltage areas, respectively. LGE was present in 26 of 29 patients (90%), whereas abnormal 18F-fluorodeoxyglucose uptake in 14 of 29 patients (48%) with imaging. Segments with abnormal EGM had more LGE-evident scar transmurality [median: 24% (interquartile range [IQR]: 4% to 40%) vs. median: 5% (IQR: 0% to 15%); p < 0.001] and lower metabolic activity (median: 20 g glucose [IQR: 14 g to 30 g] vs. median: 29 g glucose [IQR: 18 g to 39 g]; p < 0.001). Overall, the agreement between the presence of abnormal EGM was higher with the presence of LGE (kappa = 0.51; p < 0.001) than with the presence of active inflammation (kappa = -0.12; p = 0.003). CONCLUSIONS: In patients with CS and ventricular tachycardia, pre-procedural imaging with CMR and PET/CT can be useful in detecting EAM abnormalities that are potential targets for substrate ablation. Abnormal EGM were more likely located in segments with more scar transmurality (LGE) at CMR and a lower degree of inflammation on PET. CI - Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Muser, Daniele AU - Muser D AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Santangeli, Pasquale AU - Santangeli P AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Liang, Jackson J AU - Liang JJ AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Castro, Simon A AU - Castro SA AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Magnani, Silvia AU - Magnani S AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Hayashi, Tatsuya AU - Hayashi T AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Garcia, Fermin C AU - Garcia FC AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Frankel, David S AU - Frankel DS AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Dixit, Sanjay AU - Dixit S AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Zado, Erica S AU - Zado ES AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Lin, David AU - Lin D AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Desjardins, Benoit AU - Desjardins B AD - Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Callans, David J AU - Callans DJ AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Alavi, Abass AU - Alavi A AD - Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. FAU - Marchlinski, Francis E AU - Marchlinski FE AD - Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: francis.marchlinski@uphs.upenn.edu. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20171129 PL - United States TA - JACC Clin Electrophysiol JT - JACC. Clinical electrophysiology JID - 101656995 SB - IM CIN - JACC Clin Electrophysiol. 2018 Mar;4(3):304-306. PMID: 30089554 MH - Aged MH - *Cardiomyopathies/diagnostic imaging/epidemiology/pathology/physiopathology MH - Electrocardiography MH - Electrophysiologic Techniques, Cardiac MH - Female MH - Humans MH - Inflammation MH - Magnetic Resonance Imaging, Cine MH - Male MH - Middle Aged MH - Positron Emission Tomography Computed Tomography MH - *Sarcoidosis/diagnostic imaging/epidemiology/pathology/physiopathology MH - Tachycardia, Ventricular OTO - NOTNLM OT - cardiac magnetic resonance OT - cardiac positron emission tomography/computed tomography OT - cardiac sarcoidosis OT - electroanatomic mapping OT - ventricular tachycardia EDAT- 2018/08/10 06:00 MHDA- 2019/10/24 06:00 CRDT- 2018/08/10 06:00 PHST- 2017/08/16 00:00 [received] PHST- 2017/09/07 00:00 [accepted] PHST- 2018/08/10 06:00 [entrez] PHST- 2018/08/10 06:00 [pubmed] PHST- 2019/10/24 06:00 [medline] AID - S2405-500X(17)30943-X [pii] AID - 10.1016/j.jacep.2017.09.175 [doi] PST - ppublish SO - JACC Clin Electrophysiol. 2018 Mar;4(3):291-303. doi: 10.1016/j.jacep.2017.09.175. Epub 2017 Nov 29.