Magnetic resonance imaging abnormalities in the basal interventricular septum of patients with left ventricular outflow tract arrhythmias

Autor: Michael Ulbrich, Theresia Kling, Bernhard Herkommer, Christopher Reithmann, Michael Fiek
Rok vydání: 2019
Předmět:
Adult
Male
Tachycardia
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Action Potentials
Catheter ablation
Ventricular Septum
030204 cardiovascular system & hematology
Ventricular tachycardia
Ventricular Function
Left
03 medical and health sciences
Basal (phylogenetics)
0302 clinical medicine
Heart Rate
Predictive Value of Tests
Physiology (medical)
Internal medicine
medicine
Humans
Ventricular outflow tract
cardiovascular diseases
030212 general & internal medicine
Interventricular septum
Aged
Ejection fraction
Ventricular Remodeling
medicine.diagnostic_test
business.industry
Stroke Volume
Magnetic resonance imaging
Recovery of Function
Middle Aged
medicine.disease
Fibrosis
Magnetic Resonance Imaging
Ventricular Premature Complexes
Treatment Outcome
medicine.anatomical_structure
Catheter Ablation
Tachycardia
Ventricular
cardiovascular system
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Zdroj: Journal of Cardiovascular Electrophysiology.
ISSN: 1540-8167
1045-3873
Popis: Introduction Concealed structural abnormalities were detected by delayed enhancement - magnetic resonance imaging (DE-MRI) in patients with apparently idiopathic tachycardia of left ventricular (LV) origin. Basal septal fibrosis was evaluated as a potential arrhythmia substrate in patients with left ventricular outflow tract (LVOT) arrhythmias. Methods and results A total of 22 patients with LVOT arrhythmias, including frequent monomorphic premature ventricular complexes (PVCs) in 15 patients and ventricular tachycardia (VT) in 7 patients, underwent catheter ablation and DE-MRI. A total of 19 patients with frequent PVCs and 17 patients with idiopathic VT of other origin served as a control group. Basal septal intramural fibrosis as thin strip-shaped intramyocardial DE or as marked intramyocardial DE involving >25% of wall thickness was detected more frequently in patients with LVOT arrhythmias (41% and 32%) than in patients with non LVOT arrhythmias (14% and 3%). After successful ablation, 4/16 patients with basal septal intramural fibrosis and LVOT PVCs (n = 3) or LVOT VT (n = 1) compared with no patient without basal septal fibrosis experienced episodes of sustained VT with similar or different QRS morphology resulting in ICD therapy in three patients. Follow-up DE-MRI after PVC ablation (17 ± 7 months) revealed an increase in LV ejection fraction from 49 ± 5% to 56 ± 5% (n = 9) but the amount of septal DE remained unchanged. Conclusions Basal septal intramural fibrosis may serve as the arrhythmia substrate in a substantial part of patients with premature ventricular complexes (PVCs) and VT originating from the LVOT and identifies patients with continued risk for VT recurrence after initially successful ablation of LVOT arrhythmias.
Databáze: OpenAIRE
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