AUTHOR=Whitaker John , Neji Radhouene , Kim Steven , Connolly Adam , Aubriot Thierry , Calvo Justo Juliá , Karim Rashed , Roney Caroline H. , Murfin Brendan , Richardson Carla , Morgan Stephen , Ismail Tevfik F. , Harrison James , de Vos Judith , Aalders Maurice C. G. , Williams Steven E. , Mukherjee Rahul , O'Neill Louisa , Chubb Henry , Tschabrunn Cory , Anter Elad , Camporota Luigi , Niederer Steven , Roujol Sébastien , Bishop Martin J. , Wright Matthew , Silberbauer John , Razavi Reza , O'Neill Mark 

TITLE=Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Assessment of Substrate for Ventricular Tachycardia With Hemodynamic Compromise

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.744779

DOI=10.3389/fcvm.2021.744779

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> The majority of data regarding tissue substrate for post myocardial infarction (MI) VT has been collected during hemodynamically tolerated VT, which may be distinct from the substrate responsible for VT with hemodynamic compromise (VT-HC). This study aimed to characterize tissue at diastolic locations of VT-HC in a porcine model.</p><p><bold>Methods:</bold> Late Gadolinium Enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging was performed in eight pigs with healed antero-septal infarcts. Seven pigs underwent electrophysiology study with venous arterial-extra corporeal membrane oxygenation (VA-ECMO) support. Tissue thickness, scar and heterogeneous tissue (HT) transmurality were calculated at the location of the diastolic electrograms of mapped VT-HC.</p><p><bold>Results:</bold> Diastolic locations had median scar transmurality of 33.1% and a median HT transmurality 7.6%. Diastolic activation was found within areas of non-transmural scar in 80.1% of cases. Tissue activated during the diastolic component of VT circuits was thinner than healthy tissue (median thickness: 5.5 mm vs. 8.2 mm healthy tissue, <italic>p</italic> &lt; 0.0001) and closer to HT (median distance diastolic tissue: 2.8 mm vs. 11.4 mm healthy tissue, <italic>p</italic> &lt; 0.0001). Non-scarred regions with diastolic activation were closer to steep gradients in thickness than non-scarred locations with normal EGMs (diastolic locations distance = 1.19 mm vs. 9.67 mm for non-diastolic locations, <italic>p</italic> &lt; 0.0001). Sites activated late in diastole were closest to steep gradients in tissue thickness.</p><p><bold>Conclusions:</bold> Non-transmural scar, mildly decreased tissue thickness, and steep gradients in tissue thickness represent the structural characteristics of the diastolic component of reentrant circuits in VT-HC in this porcine model and could form the basis for imaging criteria to define ablation targets in future trials.</p>