Heterogeneous distribution of substrates between the endocardium and epicardium promotes ventricular fibrillation in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Chin Yu Lin, Yenn Jiang Lin, Cheng Hung Li, Fa Po Chung, Men Tzung Lo, Chen Lin, Hsiang Chih Chang, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Yao Ting Chang, Chung-Hsing Lin, Yun Yu Chen, Rohit Walia, Abigail Louise D. Te, Shinya Yamada, Tsu Juey Wu, Shih Ann Chen

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aims Whether the distribution of scar in arrhythmogenic right ventricular cardiomyopathy (ARVC) plays a role in predicting different types of ventricular arrhythmias is unknown. This study aimed to investigate the prognostic value of scar distribution in patients with ARVC. Methods and results We studied 80 consecutive ARVC patients (46 men, mean age 47 ± 15 years) who underwent an electrophysiological study with ablation. Thirty-four patients receive both endocardial and epicardial mapping. Abnormal endocardial substrates and epicardial substrates were characterized. Three groups were defined according to the epicardial and endocardial scar gradient (<10%: transmural, 10-20%: intermediate, >20%: horizontal, as groups 1, 2, and 3, respectively). Sinus rhythm electrograms underwent a Hilbert-Huang spectral analysis and were displayed as 3D Simultaneous Amplitude Frequency Electrogram Transformation (SAFE-T) maps, which represented the arrhythmogenic potentials. The baseline characteristics were similar between the three groups. Group 3 patients had a higher incidence of fatal ventricular arrhythmias requiring defibrillation and cardiac arrest during the initial presentation despite having fewer premature ventricular complexes. A larger area of arrhythmogenic potentials in the epicardium was observed in patients with horizontal scar. The epicardial-endocardial scar gradient was independently associated with the occurrence of fatal ventricular arrhythmias after a multivariate adjustment. The total, ventricular tachycardia, and VF recurrent rates were higher in Group 3 during 38 ± 21 months of follow-up. Conclusion For ARVC, the epicardial substrate that extended in the horizontal plane rather than transmurally provided the arrhythmogenic substrate for a fatal ventricular arrhythmia circuit.

Original languageEnglish
Pages (from-to)501-511
Number of pages11
JournalEuropace
Volume20
Issue number3
DOIs
Publication statusPublished - Mar 1 2018
Externally publishedYes

Fingerprint

Arrhythmogenic Right Ventricular Dysplasia
Endocardium
Pericardium
Ventricular Fibrillation
Cicatrix
Cardiac Arrhythmias
Epicardial Mapping
Ventricular Premature Complexes
Ventricular Tachycardia
Heart Arrest
Incidence

Keywords

  • Electroanatomic mapping
  • Hilbert-Huang transform
  • Sudden cardiac death
  • Ventricular fibrillation
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Heterogeneous distribution of substrates between the endocardium and epicardium promotes ventricular fibrillation in arrhythmogenic right ventricular dysplasia/cardiomyopathy. / Lin, Chin Yu; Lin, Yenn Jiang; Li, Cheng Hung; Chung, Fa Po; Lo, Men Tzung; Lin, Chen; Chang, Hsiang Chih; Chang, Shih Lin; Lo, Li Wei; Hu, Yu Feng; Chang, Yao Ting; Lin, Chung-Hsing; Chen, Yun Yu; Walia, Rohit; Te, Abigail Louise D.; Yamada, Shinya; Wu, Tsu Juey; Chen, Shih Ann.

In: Europace, Vol. 20, No. 3, 01.03.2018, p. 501-511.

Research output: Contribution to journalArticle

Lin, CY, Lin, YJ, Li, CH, Chung, FP, Lo, MT, Lin, C, Chang, HC, Chang, SL, Lo, LW, Hu, YF, Chang, YT, Lin, C-H, Chen, YY, Walia, R, Te, ALD, Yamada, S, Wu, TJ & Chen, SA 2018, 'Heterogeneous distribution of substrates between the endocardium and epicardium promotes ventricular fibrillation in arrhythmogenic right ventricular dysplasia/cardiomyopathy', Europace, vol. 20, no. 3, pp. 501-511. https://doi.org/10.1093/europace/euw393
Lin, Chin Yu ; Lin, Yenn Jiang ; Li, Cheng Hung ; Chung, Fa Po ; Lo, Men Tzung ; Lin, Chen ; Chang, Hsiang Chih ; Chang, Shih Lin ; Lo, Li Wei ; Hu, Yu Feng ; Chang, Yao Ting ; Lin, Chung-Hsing ; Chen, Yun Yu ; Walia, Rohit ; Te, Abigail Louise D. ; Yamada, Shinya ; Wu, Tsu Juey ; Chen, Shih Ann. / Heterogeneous distribution of substrates between the endocardium and epicardium promotes ventricular fibrillation in arrhythmogenic right ventricular dysplasia/cardiomyopathy. In: Europace. 2018 ; Vol. 20, No. 3. pp. 501-511.
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abstract = "Aims Whether the distribution of scar in arrhythmogenic right ventricular cardiomyopathy (ARVC) plays a role in predicting different types of ventricular arrhythmias is unknown. This study aimed to investigate the prognostic value of scar distribution in patients with ARVC. Methods and results We studied 80 consecutive ARVC patients (46 men, mean age 47 ± 15 years) who underwent an electrophysiological study with ablation. Thirty-four patients receive both endocardial and epicardial mapping. Abnormal endocardial substrates and epicardial substrates were characterized. Three groups were defined according to the epicardial and endocardial scar gradient (<10{\%}: transmural, 10-20{\%}: intermediate, >20{\%}: horizontal, as groups 1, 2, and 3, respectively). Sinus rhythm electrograms underwent a Hilbert-Huang spectral analysis and were displayed as 3D Simultaneous Amplitude Frequency Electrogram Transformation (SAFE-T) maps, which represented the arrhythmogenic potentials. The baseline characteristics were similar between the three groups. Group 3 patients had a higher incidence of fatal ventricular arrhythmias requiring defibrillation and cardiac arrest during the initial presentation despite having fewer premature ventricular complexes. A larger area of arrhythmogenic potentials in the epicardium was observed in patients with horizontal scar. The epicardial-endocardial scar gradient was independently associated with the occurrence of fatal ventricular arrhythmias after a multivariate adjustment. The total, ventricular tachycardia, and VF recurrent rates were higher in Group 3 during 38 ± 21 months of follow-up. Conclusion For ARVC, the epicardial substrate that extended in the horizontal plane rather than transmurally provided the arrhythmogenic substrate for a fatal ventricular arrhythmia circuit.",
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T1 - Heterogeneous distribution of substrates between the endocardium and epicardium promotes ventricular fibrillation in arrhythmogenic right ventricular dysplasia/cardiomyopathy

AU - Lin, Chin Yu

AU - Lin, Yenn Jiang

AU - Li, Cheng Hung

AU - Chung, Fa Po

AU - Lo, Men Tzung

AU - Lin, Chen

AU - Chang, Hsiang Chih

AU - Chang, Shih Lin

AU - Lo, Li Wei

AU - Hu, Yu Feng

AU - Chang, Yao Ting

AU - Lin, Chung-Hsing

AU - Chen, Yun Yu

AU - Walia, Rohit

AU - Te, Abigail Louise D.

AU - Yamada, Shinya

AU - Wu, Tsu Juey

AU - Chen, Shih Ann

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Aims Whether the distribution of scar in arrhythmogenic right ventricular cardiomyopathy (ARVC) plays a role in predicting different types of ventricular arrhythmias is unknown. This study aimed to investigate the prognostic value of scar distribution in patients with ARVC. Methods and results We studied 80 consecutive ARVC patients (46 men, mean age 47 ± 15 years) who underwent an electrophysiological study with ablation. Thirty-four patients receive both endocardial and epicardial mapping. Abnormal endocardial substrates and epicardial substrates were characterized. Three groups were defined according to the epicardial and endocardial scar gradient (<10%: transmural, 10-20%: intermediate, >20%: horizontal, as groups 1, 2, and 3, respectively). Sinus rhythm electrograms underwent a Hilbert-Huang spectral analysis and were displayed as 3D Simultaneous Amplitude Frequency Electrogram Transformation (SAFE-T) maps, which represented the arrhythmogenic potentials. The baseline characteristics were similar between the three groups. Group 3 patients had a higher incidence of fatal ventricular arrhythmias requiring defibrillation and cardiac arrest during the initial presentation despite having fewer premature ventricular complexes. A larger area of arrhythmogenic potentials in the epicardium was observed in patients with horizontal scar. The epicardial-endocardial scar gradient was independently associated with the occurrence of fatal ventricular arrhythmias after a multivariate adjustment. The total, ventricular tachycardia, and VF recurrent rates were higher in Group 3 during 38 ± 21 months of follow-up. Conclusion For ARVC, the epicardial substrate that extended in the horizontal plane rather than transmurally provided the arrhythmogenic substrate for a fatal ventricular arrhythmia circuit.

AB - Aims Whether the distribution of scar in arrhythmogenic right ventricular cardiomyopathy (ARVC) plays a role in predicting different types of ventricular arrhythmias is unknown. This study aimed to investigate the prognostic value of scar distribution in patients with ARVC. Methods and results We studied 80 consecutive ARVC patients (46 men, mean age 47 ± 15 years) who underwent an electrophysiological study with ablation. Thirty-four patients receive both endocardial and epicardial mapping. Abnormal endocardial substrates and epicardial substrates were characterized. Three groups were defined according to the epicardial and endocardial scar gradient (<10%: transmural, 10-20%: intermediate, >20%: horizontal, as groups 1, 2, and 3, respectively). Sinus rhythm electrograms underwent a Hilbert-Huang spectral analysis and were displayed as 3D Simultaneous Amplitude Frequency Electrogram Transformation (SAFE-T) maps, which represented the arrhythmogenic potentials. The baseline characteristics were similar between the three groups. Group 3 patients had a higher incidence of fatal ventricular arrhythmias requiring defibrillation and cardiac arrest during the initial presentation despite having fewer premature ventricular complexes. A larger area of arrhythmogenic potentials in the epicardium was observed in patients with horizontal scar. The epicardial-endocardial scar gradient was independently associated with the occurrence of fatal ventricular arrhythmias after a multivariate adjustment. The total, ventricular tachycardia, and VF recurrent rates were higher in Group 3 during 38 ± 21 months of follow-up. Conclusion For ARVC, the epicardial substrate that extended in the horizontal plane rather than transmurally provided the arrhythmogenic substrate for a fatal ventricular arrhythmia circuit.

KW - Electroanatomic mapping

KW - Hilbert-Huang transform

KW - Sudden cardiac death

KW - Ventricular fibrillation

KW - Ventricular tachycardia

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