PMID- 33358663
OWN - NLM
STAT- MEDLINE
DCOM- 20211022
LR  - 20211022
IS  - 2405-5018 (Electronic)
IS  - 2405-500X (Linking)
VI  - 7
IP  - 6
DP  - 2021 Jun
TI  - Impact of Intramural Scar on Mapping and Ablation of Premature Ventricular 
      Complexes.
PG  - 733-741
LID - S2405-500X(20)31125-7 [pii]
LID - 10.1016/j.jacep.2020.11.004 [doi]
AB  - OBJECTIVES: This study sought to determine intramural scar characteristics 
      associated with successful premature ventricular complex (PVC) ablations. 
      BACKGROUND: Ablating ventricular arrhythmias (VAs) originating from intramural 
      scarring can be challenging. Imaging of intramural scar location may help to 
      determine whether the scar is within reach of the ablation catheter. METHODS: 
      Mapping and ablation of premature ventricular complexes (PVCs) was performed in a 
      consecutive series of patients with intramural scarring and frequent PVCs. Data 
      from delayed enhanced cardiac magnetic resonance were assessed and the proximity 
      of the endocardium containing the breakout site to the intramural scar was 
      correlated with outcomes. RESULTS: Fifty-six patients were included, and 
      intramural VAs were successfully targeted in 42 patients (75%) and ablation 
      failed in 14 patients (25%). Scarring was more superficial to the endocardium in 
      patients with successful ablations compared with patients with failed procedures 
      (0.35 mm [interquartile range (IQR): 0.22 to 1.20 mm] vs. 2.45 mm [IQR: 1.60 to 
      3.13 mm]; p < 0.001). In 18 (32%) patients, ablation at the breakout site 
      resulted in a significant change of the PVC-QRS morphology that could 
      successfully be ablated in 9 of 12 patients from another anatomical aspect of the 
      wall harboring the intramural scar. The scar was larger in size (1.79 cm(3) [IQR: 
      1.25 to 2.85 cm(3)] vs. 1.00 cm(3) [IQR: 0.59 to 1.68 cm(3)]; p < 0.005) compared 
      with patients who did not have a change in the PVC-QRS morphology with ablation. 
      CONCLUSIONS: VAs in patients with intramural scaring can be successfully ablated 
      especially if the intramural scar is within close proximity to the anatomic area 
      containing the breakout site. Changes in the QRS-PVC morphology often precede 
      successful ablation at another breakout site and indicate larger intramural 
      scars.
CI  - Copyright (c) 2021 American College of Cardiology Foundation. All rights reserved.
FAU - Ghannam, Michael
AU  - Ghannam M
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, 
      USA.
FAU - Liang, Jackson J
AU  - Liang JJ
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, 
      USA.
FAU - Dabbagh, Ghaith Sharaf
AU  - Dabbagh GS
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, 
      USA.
FAU - Siontis, Konstantinos C
AU  - Siontis KC
AD  - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Attili, Anil
AU  - Attili A
AD  - Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
FAU - Cochet, Hubert
AU  - Cochet H
AD  - Electrophysiology and Ablation Unit, Bordeaux University Hospital, University of 
      Bordeaux, Bordeaux, France; INRIA Sophia Antipolis, Sophia Antipolis, France.
FAU - Jais, Pierre
AU  - Jais P
AD  - Electrophysiology and Ablation Unit, Bordeaux University Hospital, University of 
      Bordeaux, Bordeaux, France; INRIA Sophia Antipolis, Sophia Antipolis, France.
FAU - Juhoor, Mehdi
AU  - Juhoor M
AD  - Electrophysiology and Ablation Unit, Bordeaux University Hospital, University of 
      Bordeaux, Bordeaux, France; INRIA Sophia Antipolis, Sophia Antipolis, France.
FAU - Latchamsetty, Rakesh
AU  - Latchamsetty R
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, 
      USA.
FAU - Jongnarangsin, Krit
AU  - Jongnarangsin K
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, 
      USA.
FAU - Morady, Fred
AU  - Morady F
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, 
      USA.
FAU - Bogun, Frank
AU  - Bogun F
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, 
      USA. Electronic address: fbogun@umich.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20201224
PL  - United States
TA  - JACC Clin Electrophysiol
JT  - JACC. Clinical electrophysiology
JID - 101656995
SB  - IM
CIN - JACC Clin Electrophysiol. 2021 Jun;7(6):742-744. PMID: 34167751
MH  - *Catheter Ablation
MH  - Cicatrix/diagnostic imaging/pathology
MH  - Endocardium/pathology
MH  - Humans
MH  - *Tachycardia, Ventricular/surgery
MH  - *Ventricular Premature Complexes/surgery
OTO - NOTNLM
OT  - cardiac magnetic resonance
OT  - catheter ablation
OT  - premature ventricular contraction
COIS- FUNDING SUPPORT AND Author Disclosures This research was supported by funding 
      from the French National Research Agency (Grant Nos. Equipex MUSIC 
      ANR-11-EQPX-0030 and IHU LIRYC ANR-10-IAHU-04 to Drs. Cochet, Jais, and Juhoor) 
      and the European Research Council (Grant No. 715093 to Drs. Cochet, Jais, and 
      Juhoor). The authors have reported that they have no relationships relevant to 
      the contents of this paper to disclose.
EDAT- 2020/12/29 06:00
MHDA- 2023/02/25 06:00
CRDT- 2020/12/28 10:39
PHST- 2020/08/10 00:00 [received]
PHST- 2020/11/02 00:00 [revised]
PHST- 2020/11/03 00:00 [accepted]
PHST- 2020/12/29 06:00 [pubmed]
PHST- 2023/02/25 06:00 [medline]
PHST- 2020/12/28 10:39 [entrez]
AID - S2405-500X(20)31125-7 [pii]
AID - 10.1016/j.jacep.2020.11.004 [doi]
PST - ppublish
SO  - JACC Clin Electrophysiol. 2021 Jun;7(6):733-741. doi: 
      10.1016/j.jacep.2020.11.004. Epub 2020 Dec 24.