PMID- 31589989 OWN - NLM STAT- MEDLINE DCOM- 20210505 LR - 20231113 IS - 1556-3871 (Electronic) IS - 1547-5271 (Print) IS - 1547-5271 (Linking) VI - 17 IP - 3 DP - 2020 Mar TI - Ventricular arrhythmia risk prediction in repaired Tetralogy of Fallot using personalized computational cardiac models. PG - 408-414 LID - S1547-5271(19)30908-7 [pii] LID - 10.1016/j.hrthm.2019.10.002 [doi] AB - BACKGROUND: Adults with repaired tetralogy of Fallot (rTOF) are at increased risk for ventricular tachycardia (VT) due to fibrotic remodeling of the myocardium. However, the current clinical guidelines for VT risk stratification and subsequent implantable cardioverter-defibrillator deployment for primary prevention of sudden cardiac death in rTOF remain inadequate. OBJECTIVE: The purpose of this study was to determine the feasibility of using an rTOF-specific virtual-heart approach to identify patients stratified incorrectly as being at low VT risk by current clinical criteria. METHODS: This multicenter retrospective pilot study included 7 adult rTOF patients who were considered low risk for VT based on clinical criteria. Patient-specific computational heart models were generated from late gadolinium enhanced magnetic resonance imaging (LGE-MRI), incorporating the individual distribution of rTOF fibrotic remodeling in both ventricles. Simulations of rapid pacing determined VT inducibility. Model creation and simulations were performed by operators blinded to clinical outcome. RESULTS: Two patients in the study experienced clinical VT. The virtual hearts constructed from LGE-MRI scans of 7 rTOF patients correctly predicted reentrant VT in the models from VT-positive patients and no arrhythmia in those from VT-negative patients. There were no statistically significant differences in clinical criteria commonly used to assess VT risk, including QRS duration and age, between patients who did and those who did not experience clinical VT. CONCLUSION: This study demonstrates the feasibility of image-based virtual-heart modeling in patients with congenital heart disease and structurally abnormal hearts. It highlights the potential of the methodology to improve VT risk stratification in patients with rTOF. CI - Copyright (c) 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. FAU - Shade, Julie K AU - Shade JK AD - Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Alliance for Cardiovascular Diagnostic and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, Baltimore, Maryland. FAU - Cartoski, Mark J AU - Cartoski MJ AD - Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland. FAU - Nikolov, Plamen AU - Nikolov P AD - Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland. FAU - Prakosa, Adityo AU - Prakosa A AD - Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Alliance for Cardiovascular Diagnostic and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, Baltimore, Maryland. FAU - Doshi, Ashish AU - Doshi A AD - Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Alliance for Cardiovascular Diagnostic and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, Baltimore, Maryland. FAU - Binka, Edem AU - Binka E AD - Alliance for Cardiovascular Diagnostic and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, Baltimore, Maryland; Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland. FAU - Olivieri, Laura AU - Olivieri L AD - Division of Cardiology, Children's National Medical Center, Washington, DC. FAU - Boyle, Patrick M AU - Boyle PM AD - Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland. FAU - Spevak, Philip J AU - Spevak PJ AD - Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland. FAU - Trayanova, Natalia A AU - Trayanova NA AD - Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Alliance for Cardiovascular Diagnostic and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, Baltimore, Maryland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: ntrayanova@jhu.edu. LA - eng GR - R01 HL142893/HL/NHLBI NIH HHS/United States GR - DP1 HL123271/HL/NHLBI NIH HHS/United States GR - R01 HL142496/HL/NHLBI NIH HHS/United States GR - T32 HL125239/HL/NHLBI NIH HHS/United States GR - R01 HL126802/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20191004 PL - United States TA - Heart Rhythm JT - Heart rhythm JID - 101200317 SB - IM MH - Adolescent MH - Adult MH - *Computer Simulation MH - Female MH - Heart Ventricles/diagnostic imaging/*physiopathology MH - Humans MH - Magnetic Resonance Imaging, Cine/methods MH - Male MH - Middle Aged MH - Myocardium/*pathology MH - Pilot Projects MH - Prognosis MH - Retrospective Studies MH - Tachycardia, Ventricular/diagnosis/*etiology/physiopathology MH - Tetralogy of Fallot/*complications/surgery MH - *Ventricular Remodeling MH - Young Adult PMC - PMC7056519 MID - NIHMS1544054 OTO - NOTNLM OT - Arrhythmia OT - Computer simulation OT - Electrophysiology OT - Magnetic resonance imaging OT - Tetralogy of Fallot OT - Ventricular tachycardia COIS- Conflicts of Interest: The authors have no conflicts of interest to disclose. EDAT- 2019/10/08 06:00 MHDA- 2021/05/06 06:00 PMCR- 2021/03/01 CRDT- 2019/10/08 06:00 PHST- 2019/04/16 00:00 [received] PHST- 2019/10/08 06:00 [pubmed] PHST- 2021/05/06 06:00 [medline] PHST- 2019/10/08 06:00 [entrez] PHST- 2021/03/01 00:00 [pmc-release] AID - S1547-5271(19)30908-7 [pii] AID - 10.1016/j.hrthm.2019.10.002 [doi] PST - ppublish SO - Heart Rhythm. 2020 Mar;17(3):408-414. doi: 10.1016/j.hrthm.2019.10.002. Epub 2019 Oct 4.