Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Assessment of Substrate for Ventricular Tachycardia With Hemodynamic Compromise

John Whitaker*, Radhouene Neji, Steven Kim, Adam Connolly, Thierry Aubriot, Justo Juliá Calvo, Rashed Karim, Caroline H. Roney, Brendan Murfin, Carla Richardson, Stephen Morgan, Tevfik F. Ismail, James Harrison, Judith de Vos, Maurice C.G. Aalders, Steven E. Williams, Rahul Mukherjee, Louisa O'Neill, Henry Chubb, Cory TschabrunnElad Anter, Luigi Camporota, Steven Niederer, Sébastien Roujol, Martin J. Bishop, Matthew Wright, John Silberbauer, Reza Razavi, Mark O'Neill

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The majority of data regarding tissue substrate for post myocardial infarction (MI) VT has been collected during hemodynamically tolerated VT, which may be distinct from the substrate responsible for VT with hemodynamic compromise (VT-HC). This study aimed to characterize tissue at diastolic locations of VT-HC in a porcine model. Methods: Late Gadolinium Enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging was performed in eight pigs with healed antero-septal infarcts. Seven pigs underwent electrophysiology study with venous arterial-extra corporeal membrane oxygenation (VA-ECMO) support. Tissue thickness, scar and heterogeneous tissue (HT) transmurality were calculated at the location of the diastolic electrograms of mapped VT-HC. Results: Diastolic locations had median scar transmurality of 33.1% and a median HT transmurality 7.6%. Diastolic activation was found within areas of non-transmural scar in 80.1% of cases. Tissue activated during the diastolic component of VT circuits was thinner than healthy tissue (median thickness: 5.5 mm vs. 8.2 mm healthy tissue, p < 0.0001) and closer to HT (median distance diastolic tissue: 2.8 mm vs. 11.4 mm healthy tissue, p < 0.0001). Non-scarred regions with diastolic activation were closer to steep gradients in thickness than non-scarred locations with normal EGMs (diastolic locations distance = 1.19 mm vs. 9.67 mm for non-diastolic locations, p < 0.0001). Sites activated late in diastole were closest to steep gradients in tissue thickness. Conclusions: Non-transmural scar, mildly decreased tissue thickness, and steep gradients in tissue thickness represent the structural characteristics of the diastolic component of reentrant circuits in VT-HC in this porcine model and could form the basis for imaging criteria to define ablation targets in future trials.

Original languageEnglish
Article number744779
JournalFrontiers in Cardiovascular Medicine
Volume8
DOIs
StatePublished - 2021
Externally publishedYes

Funding

FundersFunder number
Abbott UK
Health Innovation Challenge FundHICF-R10-698
Institute de Chirurgie Guidée par l'image
Medical Research Council UK Clinical ResearchMR/N001877/1
NIHR Healthcare Technology Co-operative for Cardiovascular Disease
National Institutes of HealthR24 GM136986, P41 GM103545
National Institute of General Medical Sciences
Wellcome Trust
NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
Engineering and Physical Sciences Research Council
National Institute for Health and Care Research
British Heart FoundationFS/20/26/34952
Guy's and St Thomas' NHS Foundation Trust
Wellcome EPSRC Centre for Medical EngineeringEP/R010935/1, WT203148/Z/16/Z

    Keywords

    • cardiovascular magnetic resonance
    • late gadolinium enhancement
    • mechanical circulatory support
    • venous-arterial extra corporeal membrane oxygenation (VA-ECMO)
    • ventricular tachycardia

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