TY - JOUR
T1 - Correlation of extent of left ventricular endocardial unipolar low-voltage zones with ventricular tachycardia in nonischemic cardiomyopathy
AU - Raja, Deep Chandh
AU - Shroff, Jenish
AU - Nair, Anugrah
AU - Abhilash, Sreevilasam P.
AU - Tuan, Lukah Q.
AU - Mehta, Abhinav
AU - Abhayaratna, Walter P.
AU - Sanders, Prashanthan
AU - Frankel, David S.
AU - Marchlinski, Francis E.
AU - Pathak, Rajeev Kumar
N1 - Publisher Copyright:
© 2024 Heart Rhythm Society
PY - 2024
Y1 - 2024
N2 - Background: Endocardial electrogram (EGM) characteristics in nonischemic cardiomyopathy (NICM) have not been explored adequately for prognostication. Objective: We aimed to study correlation of bipolar and unipolar EGM characteristics with left ventricular ejection fraction (LVEF) and ventricular tachycardia (VT) in NICM. Methods: Electroanatomic mapping of the left ventricle was performed. EGM characteristics were correlated with LVEF. Differences between groups with and without VT and predictors of VT were studied. Results: In 43 patients, unipolar EGM variables had better correlation with baseline LVEF than bipolar EGM variables: unipolar voltage (r = +0.36), peak negative unipolar voltage (r = −0.42), peak positive unipolar voltage (r = +0.38), and percentage area of unipolar low-voltage zone (LVZ; r = −0.41). Global mean unipolar voltage (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.2–0.8), extent of unipolar LVZ (HR, 1.6; 95% CI, 1.1–2.3), and percentage area of unipolar LVZ (HR, 1.6; 95% CI, 1.1–2.3) were significant predictors of VT. For classification of patients with VT, extent of unipolar LVZ had an area under the curve of 0.82 (95% CI, 0.69–0.95; P < .001), and percentage area of unipolar LVZ had an area under the curve of 0.83 (95% CI, 0.71–0.96; P = .01). Cutoff of >3 segments for extent of unipolar LVZ had the best diagnostic accuracy (sensitivity, 90%; specificity, 67%) and cutoff of 33% for percentage area of unipolar LVZ had the best diagnostic accuracy (sensitivity, 95%; specificity, 60%) for VT. Conclusion: In NICM, extent and percentage area of unipolar LVZs are significant predictors of VT. Cutoffs of >3 segments of unipolar LVZ and >33% area of unipolar LVZ have good diagnostic accuracies for association with VT.
AB - Background: Endocardial electrogram (EGM) characteristics in nonischemic cardiomyopathy (NICM) have not been explored adequately for prognostication. Objective: We aimed to study correlation of bipolar and unipolar EGM characteristics with left ventricular ejection fraction (LVEF) and ventricular tachycardia (VT) in NICM. Methods: Electroanatomic mapping of the left ventricle was performed. EGM characteristics were correlated with LVEF. Differences between groups with and without VT and predictors of VT were studied. Results: In 43 patients, unipolar EGM variables had better correlation with baseline LVEF than bipolar EGM variables: unipolar voltage (r = +0.36), peak negative unipolar voltage (r = −0.42), peak positive unipolar voltage (r = +0.38), and percentage area of unipolar low-voltage zone (LVZ; r = −0.41). Global mean unipolar voltage (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.2–0.8), extent of unipolar LVZ (HR, 1.6; 95% CI, 1.1–2.3), and percentage area of unipolar LVZ (HR, 1.6; 95% CI, 1.1–2.3) were significant predictors of VT. For classification of patients with VT, extent of unipolar LVZ had an area under the curve of 0.82 (95% CI, 0.69–0.95; P < .001), and percentage area of unipolar LVZ had an area under the curve of 0.83 (95% CI, 0.71–0.96; P = .01). Cutoff of >3 segments for extent of unipolar LVZ had the best diagnostic accuracy (sensitivity, 90%; specificity, 67%) and cutoff of 33% for percentage area of unipolar LVZ had the best diagnostic accuracy (sensitivity, 95%; specificity, 60%) for VT. Conclusion: In NICM, extent and percentage area of unipolar LVZs are significant predictors of VT. Cutoffs of >3 segments of unipolar LVZ and >33% area of unipolar LVZ have good diagnostic accuracies for association with VT.
KW - Bipolar voltage
KW - Electroanatomic mapping
KW - Low-voltage zone
KW - Nonischemic cardiomyopathy
KW - Unipolar voltage
KW - Ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=85194087856&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2024.04.065
DO - 10.1016/j.hrthm.2024.04.065
M3 - Article
C2 - 38636932
AN - SCOPUS:85194087856
SN - 1547-5271
JO - Heart Rhythm
JF - Heart Rhythm
ER -