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Comparison of the arrhythmogenic substrate for ventricular tachycardia in patients with ischemic vs non-ischemic cardiomyopathy — insights from high-density, multi-electrode catheter mapping

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A Correction to this article was published on 18 February 2022

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Abstract

Purpose

The purpose of this study was to compare the differences of arrhythmogenic substrate using high-density mapping in ventricular tachycardia (VT) patients with ischemic (ICM) vs non-ischemic cardiomyopathy (NICM).

Methods

Data from patients presenting for VT ablation from December 2016 to December 2020 at Westmead Hospital were reviewed.

Results

Sixty consecutive patients with structural heart disease (ICM 57%, NICM 43%, mean age 66 years) having catheter ablation of scar-related VT with pre-dominant left ventricular involvement were included. ICM was associated with larger proportion of dense scar area (bipolar; 19 [12–29]% vs 6 [3–10]%, P < 0.001, unipolar; 20 [12–32]% vs 11 [7–19]%, P = 0.01) compared with NICM. However, the scar ratio (unipolar dense scar [%]/bipolar dense scar [%]) was significantly higher in NICM patients (1.2 [0.8–1.7] vs 1.7 [1.3–2.3], P = 0.003). Larger scar area in ICM was paralleled by higher proportion of complex electrograms (6 [2–13] % vs 3 [1–5] %, P = 0.01), longer and wider voltage based conducting channels, higher incidence of late potential-based conducting channels, longer VT cycle-length (399 ± 80 ms vs 359 ± 68 ms, P = 0.04) and greater maximal stimulation-QRS interval among sites with good pace-map correlation (75 [51–99]ms vs 48 [31–73]ms, P = 0.02). Ventricular arrhythmia (VA) storm was more highly prevalent in ICM than NICM (50% vs 23%, P = 0.03). During the follow-up period, NICM had a significantly higher cumulative incidence for the VA recurrence than ICM (P = 0.03).

Conclusions

High-density multi-electrode catheter mapping of left ventricular arrhythmogenic substrate of NICM tends to show smaller dense scar area and higher scar ratio, compared with ICM, suggestive the extent of epicardial/intramural substrate, with paucity of substrate targets for ablation, which results in the worse outcomes with ablation.

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Availability of data and material

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

Change history

Abbreviations

AAD:

Anti-arrhythmic drug

ATP:

Anti-tachycardia pacing

CF:

Contact force

CL:

Cycle length

CMR:

Cardiac magnetic resonance

CS:

Coronary sinus

EP:

Electrophysiology

HCM:

Hypertrophic cardiomyopathy

ICD:

Implantable cardioverter defibrillator

ICM:

Ischemic cardiomyopathy

IQR:

Interquartile range

LAVA:

Local abnormal ventricular activation

LV:

Left ventricle

mA:

Milliamps

mV:

Millivolts

NICM:

Non-ischemic cardiomyopathy

PES:

Programmed electrical stimulation

RV:

Right ventricle

SD:

Standard deviation

SHD:

Structural heart disease

VA:

Ventricular arrhythmia

VT:

Ventricular tachycardia

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Funding

Associate Professor Saurabh Kumar is supported by the NSW Early-mid Career Fellowship.

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Authors and Affiliations

  1. Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Hawkesbury Road, Westmead, NSW, 2145, Australia

    Yasuhito Kotake, Chrishan J. Nalliah, Timothy Campbell, Richard G. Bennett, Samual Turnbull & Saurabh Kumar

Authors
  1. Yasuhito Kotake
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  2. Chrishan J. Nalliah
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  3. Timothy Campbell
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  4. Richard G. Bennett
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  5. Samual Turnbull
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  6. Saurabh Kumar
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yasuhito Kotake, Chrishan J. Nalliah, Timothy Campbell, Richard G. Bennett, Samual Turnbull and Saurabh Kumar. The first draft of the manuscript was written by Chrishan J. Nalliah and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Saurabh Kumar.

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Ethics approval

This study was approved by the Western Sydney Local Health District Human Research Ethics Committee and complies with the Declaration of Helsinki.

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Not applicable.

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Not applicable.

Conflict of interest

Dr. Kumar has received research grants from Abbott Medical and Biotronik; he has received honoraria from Biosense Webster, Abbott Medical, Biotronik and Sanofi Aventis. Mr Campbell has received speakers Honoria from Biosense Webster. Dr. Kotake is the recipient of Nihon Koden/Abbott arrhythmia Fellowship from the Japan Heart Rhythm Society. All other authors have reported no other relationships relevant to the contents of this paper to disclose.

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Yasuhito Kotake and Chrishan J. Nalliah are equal co-first authors.

The original online version of this article was revised: In Fig. 1 of this article "F: Pace map" should have been "H: Pace map".

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Kotake, Y., Nalliah, C.J., Campbell, T. et al. Comparison of the arrhythmogenic substrate for ventricular tachycardia in patients with ischemic vs non-ischemic cardiomyopathy — insights from high-density, multi-electrode catheter mapping. J Interv Card Electrophysiol 66, 5–14 (2023). https://doi.org/10.1007/s10840-021-01088-7

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  • DOI: https://doi.org/10.1007/s10840-021-01088-7

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