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Tschabrunn CM, Zado ES, Schaller R, et al. Isolated critical epicardial arrhythmogenic substrate abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy and ventricular tachycardia. Heart Rhythm. 2021;doi: 10.1016/j.hrthm.2021.11.035.
Tschabrunn, C. M., Zado, E. S., Schaller, R., Garcia, F. C., Kumareswaran, R., Hsue, W., Santangeli, P., & Marchlinski, F. E. (2021). Isolated critical epicardial arrhythmogenic substrate abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy and ventricular tachycardia. Heart rhythm, . https://doi.org/10.1016/j.hrthm.2021.11.035
Tschabrunn, Cory M, et al. "Isolated critical epicardial arrhythmogenic substrate abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy and ventricular tachycardia." Heart rhythm vol. (2021). doi: https://doi.org/10.1016/j.hrthm.2021.11.035
Tschabrunn CM, Zado ES, Schaller R, Garcia FC, Kumareswaran R, Hsue W, Santangeli P, Marchlinski FE. Isolated critical epicardial arrhythmogenic substrate abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy and ventricular tachycardia. Heart Rhythm. 2021 Dec 06; doi: 10.1016/j.hrthm.2021.11.035. Epub 2021 Dec 06. PMID: 34883271.
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Heart Rhythm. 2021 Dec 06; doi: 10.1016/j.hrthm.2021.11.035. Epub 2021 Dec 06.

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

Heart rhythm

Cory M Tschabrunn, Erica S Zado, Robert Schaller, Fermin C Garcia, Ramanan Kumareswaran, Weihow Hsue, Pasquale Santangeli, Francis E Marchlinski

Affiliations

  1. Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
  2. Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: [email protected].

PMID: 34883271 DOI: 10.1016/j.hrthm.2021.11.035

Abstract

BACKGROUND: Ventricular tachycardia (VT) substrate abnormalities in arrhythmogenic right ventricular cardiomyopathy (ARVC) typically involve both the right ventricular (RV) endocardium (ENDO) and epicardium (EPI).

OBJECTIVE: The purpose of this study was to examine the prevalence, electrophysiological features, and outcomes of catheter ablation of VT in patients with isolated epicardial substrate (IES) abnormalities.

METHODS: We studied 71 consecutive patients with VT who met Task Force criteria for ARVC and underwent detailed ENDO and EPI mapping. Patients with critical IES demonstrated (1) confluent EPI bipolar abnormal electrograms (EGMs) and (2) no or minor (<5.0 cm

RESULTS: Twelve patients (17%) had IES. Extensive EPI bipolar low-voltage area (Bi-LVA; 74 ± 40 cm

CONCLUSION: In patients with ARVC and VT, substrate abnormalities can uncommonly be isolated to the RV EPI. Detection of critical IES may be limited with CMR imaging but suggested by ENDO unipolar EGM abnormalities. EPI ablation eliminates VT in these patients and typically results in long-term VT-free survival.

Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Keywords: Ablation; Arrhythmogenic right ventricular cardiomyopathy; Cardiac magnetic resonance imaging; Electroanatomic mapping; Ventricular tachycardia

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