Clinical significance of structural remodeling concerning substrate characteristics and outcomes in arrhythmogenic right ventricular cardiomyopathy

Chin Yu Lin; Fa Po Chung; Yenn Jiang Lin; Shih Lin Chang; Li Wei Lo; Yu Feng Hu; Ta Chuan Tuan; Tze Fan Chao; Jo Nan Liao; Ting Yung Chang; Ling Kuo; Cheng I. Wu; Chih Min Liu; Shin Huei Liu; Jin Long Huang; Yu Cheng Hsieh; Shih Ann Chen

doi:10.1016/j.hroo.2022.04.007

Clinical significance of structural remodeling concerning substrate characteristics and outcomes in arrhythmogenic right ventricular cardiomyopathy

Chin Yu Lin, Fa Po Chung, Yenn Jiang Lin^*, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Ta Chuan Tuan, Tze Fan Chao, Jo Nan Liao, Ting Yung Chang, Ling Kuo, Cheng I. Wu, Chih Min Liu, Shin Huei Liu, Jin Long Huang, Yu Cheng Hsieh, Shih Ann Chen

^*Corresponding author for this work

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: The substrate and ablation outcome in arrhythmogenic right ventricular cardiomyopathy (ARVC) with or without right ventricular (RV) dysfunction is unclear. Objective: We aimed to investigate ablation outcome and substrate in ARVC patients with or without RV dysfunction. Methods: We retrospectively studied ARVC patients with (group 1) or without RV dysfunction (group 2) undergoing substrate mapping/ablation. Baseline characteristics and electrophysiological features were compared. The RV was divided into 7 prespecified segments. The scarred segment was defined as more than 50% of the area with bipolar scar. A multivariate regression analysis was performed to predict the risk of ventricular tachycardia (VT) recurrence. Results: A total of 106 patients were enrolled (57 in group 1 and 49 in group 2). There were more men (73.7% vs 32.7%, P < .05) in group 1 than group 2. Group 1 patients demonstrated larger abnormal substrate in both the endocardium (13.4 ± 14.7 cm² vs 7.8 ± 5.4 cm², P = .014) and in the epicardium (40.3 ± 27.7 cm² vs 14.2 ± 12.6 cm², P = .002) and had more scar in the inferior portion/tricuspid valve (TV) than group 2 patients. Twenty-five patients had recurrences of VT/ventricular fibrillation. After multivariate analysis, the presence of a superior TV scar in the endocardium predicted the recurrence in patients with sustained VT. Conclusion: The presence of RV dysfunction was associated with a larger abnormal substrate in the endocardium and epicardium of the RV. A scar involving the inferior portion and TV is associated with RV dysfunction. Scarring in the superior TV of the endocardium can predict recurrence despite catheter ablation.

Original language	English
Journal	Heart Rhythm O2
DOIs	https://doi.org/10.1016/j.hroo.2022.04.007
State	Accepted/In press - 2022

Keywords

Ablation
Arrhythmogenic right ventricular cardiomyopathy
Right ventricular dysfunction
Scar
Ventricular arrhythmia

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10.1016/j.hroo.2022.04.007

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Lin, C. Y., Chung, F. P., Lin, Y. J., Chang, S. L., Lo, L. W., Hu, Y. F., Tuan, T. C., Chao, T. F., Liao, J. N., Chang, T. Y., Kuo, L., Wu, C. I., Liu, C. M., Liu, S. H., Huang, J. L., Hsieh, Y. C., & Chen, S. A. (Accepted/In press). Clinical significance of structural remodeling concerning substrate characteristics and outcomes in arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm O2. https://doi.org/10.1016/j.hroo.2022.04.007

@article{10945fc1560d4cfb999f021c017ac0dd,

title = "Clinical significance of structural remodeling concerning substrate characteristics and outcomes in arrhythmogenic right ventricular cardiomyopathy",

abstract = "Background: The substrate and ablation outcome in arrhythmogenic right ventricular cardiomyopathy (ARVC) with or without right ventricular (RV) dysfunction is unclear. Objective: We aimed to investigate ablation outcome and substrate in ARVC patients with or without RV dysfunction. Methods: We retrospectively studied ARVC patients with (group 1) or without RV dysfunction (group 2) undergoing substrate mapping/ablation. Baseline characteristics and electrophysiological features were compared. The RV was divided into 7 prespecified segments. The scarred segment was defined as more than 50% of the area with bipolar scar. A multivariate regression analysis was performed to predict the risk of ventricular tachycardia (VT) recurrence. Results: A total of 106 patients were enrolled (57 in group 1 and 49 in group 2). There were more men (73.7% vs 32.7%, P < .05) in group 1 than group 2. Group 1 patients demonstrated larger abnormal substrate in both the endocardium (13.4 ± 14.7 cm2 vs 7.8 ± 5.4 cm2, P = .014) and in the epicardium (40.3 ± 27.7 cm2 vs 14.2 ± 12.6 cm2, P = .002) and had more scar in the inferior portion/tricuspid valve (TV) than group 2 patients. Twenty-five patients had recurrences of VT/ventricular fibrillation. After multivariate analysis, the presence of a superior TV scar in the endocardium predicted the recurrence in patients with sustained VT. Conclusion: The presence of RV dysfunction was associated with a larger abnormal substrate in the endocardium and epicardium of the RV. A scar involving the inferior portion and TV is associated with RV dysfunction. Scarring in the superior TV of the endocardium can predict recurrence despite catheter ablation.",

keywords = "Ablation, Arrhythmogenic right ventricular cardiomyopathy, Right ventricular dysfunction, Scar, Ventricular arrhythmia",

author = "Lin, {Chin Yu} and Chung, {Fa Po} and Lin, {Yenn Jiang} and Chang, {Shih Lin} and Lo, {Li Wei} and Hu, {Yu Feng} and Tuan, {Ta Chuan} and Chao, {Tze Fan} and Liao, {Jo Nan} and Chang, {Ting Yung} and Ling Kuo and Wu, {Cheng I.} and Liu, {Chih Min} and Liu, {Shin Huei} and Huang, {Jin Long} and Hsieh, {Yu Cheng} and Chen, {Shih Ann}",

note = "Publisher Copyright: {\textcopyright} 2022 Heart Rhythm Society",

year = "2022",

doi = "10.1016/j.hroo.2022.04.007",

language = "English",

journal = "Heart Rhythm O2",

issn = "2666-5018",

publisher = "Elsevier Inc.",

}

Lin, CY, Chung, FP, Lin, YJ , Chang, SL , Lo, LW , Hu, YF, Tuan, TC, Chao, TF, Liao, JN, Chang, TY, Kuo, L, Wu, CI, Liu, CM, Liu, SH, Huang, JL, Hsieh, YC & Chen, SA 2022, 'Clinical significance of structural remodeling concerning substrate characteristics and outcomes in arrhythmogenic right ventricular cardiomyopathy', Heart Rhythm O2. https://doi.org/10.1016/j.hroo.2022.04.007

TY - JOUR

T1 - Clinical significance of structural remodeling concerning substrate characteristics and outcomes in arrhythmogenic right ventricular cardiomyopathy

AU - Lin, Chin Yu

AU - Chung, Fa Po

AU - Lin, Yenn Jiang

AU - Chang, Shih Lin

AU - Lo, Li Wei

AU - Hu, Yu Feng

AU - Tuan, Ta Chuan

AU - Chao, Tze Fan

AU - Liao, Jo Nan

AU - Chang, Ting Yung

AU - Kuo, Ling

AU - Wu, Cheng I.

AU - Liu, Chih Min

AU - Liu, Shin Huei

AU - Huang, Jin Long

AU - Hsieh, Yu Cheng

AU - Chen, Shih Ann

PY - 2022

Y1 - 2022

N2 - Background: The substrate and ablation outcome in arrhythmogenic right ventricular cardiomyopathy (ARVC) with or without right ventricular (RV) dysfunction is unclear. Objective: We aimed to investigate ablation outcome and substrate in ARVC patients with or without RV dysfunction. Methods: We retrospectively studied ARVC patients with (group 1) or without RV dysfunction (group 2) undergoing substrate mapping/ablation. Baseline characteristics and electrophysiological features were compared. The RV was divided into 7 prespecified segments. The scarred segment was defined as more than 50% of the area with bipolar scar. A multivariate regression analysis was performed to predict the risk of ventricular tachycardia (VT) recurrence. Results: A total of 106 patients were enrolled (57 in group 1 and 49 in group 2). There were more men (73.7% vs 32.7%, P < .05) in group 1 than group 2. Group 1 patients demonstrated larger abnormal substrate in both the endocardium (13.4 ± 14.7 cm2 vs 7.8 ± 5.4 cm2, P = .014) and in the epicardium (40.3 ± 27.7 cm2 vs 14.2 ± 12.6 cm2, P = .002) and had more scar in the inferior portion/tricuspid valve (TV) than group 2 patients. Twenty-five patients had recurrences of VT/ventricular fibrillation. After multivariate analysis, the presence of a superior TV scar in the endocardium predicted the recurrence in patients with sustained VT. Conclusion: The presence of RV dysfunction was associated with a larger abnormal substrate in the endocardium and epicardium of the RV. A scar involving the inferior portion and TV is associated with RV dysfunction. Scarring in the superior TV of the endocardium can predict recurrence despite catheter ablation.

AB - Background: The substrate and ablation outcome in arrhythmogenic right ventricular cardiomyopathy (ARVC) with or without right ventricular (RV) dysfunction is unclear. Objective: We aimed to investigate ablation outcome and substrate in ARVC patients with or without RV dysfunction. Methods: We retrospectively studied ARVC patients with (group 1) or without RV dysfunction (group 2) undergoing substrate mapping/ablation. Baseline characteristics and electrophysiological features were compared. The RV was divided into 7 prespecified segments. The scarred segment was defined as more than 50% of the area with bipolar scar. A multivariate regression analysis was performed to predict the risk of ventricular tachycardia (VT) recurrence. Results: A total of 106 patients were enrolled (57 in group 1 and 49 in group 2). There were more men (73.7% vs 32.7%, P < .05) in group 1 than group 2. Group 1 patients demonstrated larger abnormal substrate in both the endocardium (13.4 ± 14.7 cm2 vs 7.8 ± 5.4 cm2, P = .014) and in the epicardium (40.3 ± 27.7 cm2 vs 14.2 ± 12.6 cm2, P = .002) and had more scar in the inferior portion/tricuspid valve (TV) than group 2 patients. Twenty-five patients had recurrences of VT/ventricular fibrillation. After multivariate analysis, the presence of a superior TV scar in the endocardium predicted the recurrence in patients with sustained VT. Conclusion: The presence of RV dysfunction was associated with a larger abnormal substrate in the endocardium and epicardium of the RV. A scar involving the inferior portion and TV is associated with RV dysfunction. Scarring in the superior TV of the endocardium can predict recurrence despite catheter ablation.

KW - Ablation

KW - Arrhythmogenic right ventricular cardiomyopathy

KW - Right ventricular dysfunction

KW - Scar

KW - Ventricular arrhythmia

UR - http://www.scopus.com/inward/record.url?scp=85131507076&partnerID=8YFLogxK

U2 - 10.1016/j.hroo.2022.04.007

DO - 10.1016/j.hroo.2022.04.007

M3 - Article

AN - SCOPUS:85131507076

SN - 2666-5018

JO - Heart Rhythm O2

JF - Heart Rhythm O2

ER -

Clinical significance of structural remodeling concerning substrate characteristics and outcomes in arrhythmogenic right ventricular cardiomyopathy

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Keywords

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