This Article Figures Only Full Text Full Text (PDF) View Related Cardiosource Journal Scan Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (11) Citing Articles via Google Scholar Google Scholar Articles by Bogun, F. M. Articles by Morady, F. Search for Related Content PubMed PubMed Citation Articles by Bogun, F. M. Articles by Morady, F. Related Collections Related Articles

CLINICAL RESEARCH: CARDIAC IMAGING

Delayed-Enhanced Magnetic Resonance Imaging in Nonischemic Cardiomyopathy

Utility for Identifying the Ventricular Arrhythmia Substrate

University of Michigan Medical Center, Ann Arbor, Michigan

Manuscript received July 28, 2008; revised manuscript received November 12, 2008, accepted November 24, 2008.

^_* Reprint requests and correspondence: Dr. Frank M. Bogun, Division of Cardiology, University of Michigan Health Systems, 1500 East Medical Center Drive, SPC 5853, Ann Arbor, Michigan 48109-5853 (Email: fbogun{at}med.umich.edu).

Objectives: The purpose of this study was to assess the value of delayed-enhanced magnetic resonance imaging (DE-MRI) to guide ablation of ventricular arrhythmias in patients with nonischemic cardiomyopathy (NIC).

Background: In patients with NIC, ventricular arrhythmias often are associated with scar tissue. DE-MRI can be used to precisely define scar tissue.

Methods: DE-MRI was performed in 29 consecutive patients (mean age 50 ± 15 years) with NIC (mean ejection fraction 37 ± 9%) referred for catheter ablation of ventricular tachycardia (VT) or premature ventricular complexes (PVCs). Scar was extracted from DE-MRIs and was then integrated into the electroanatomic map. Mapping data were correlated with respect to the localization of scar tissue.

Results: Scar was identified by DE-MRI in 14 of 29 patients. Nine of these patients had VT and 5 had PVCs. In 5 of the patients there was predominantly endocardial scar, and mapping and ablation of arrhythmias was effectively performed from the endocardium in all 5 patients. In 2 patients scar was either intramural or epicardial with extension to the endocardium. In both patients with partial endocardial scar extension, the ablation was effective in eliminating some but not all arrhythmias. In 2 patients most of the scar tissue was confined to the epicardium; mapping identified and eliminated an epicardial origin in both patients. No effect on arrhythmias could be achieved in the other 5 patients with predominantly intramural scar.

Conclusions: DE-MRI in patients without prior infarctions can help to identify the arrhythmogenic substrate; furthermore, it helps to plan an appropriate mapping and ablation strategy.

Key Words: nonischemic cardiomyopathy • mapping • ablation • ventricular tachycardia • magnetic resonance imaging

Abbreviations and Acronyms   3D = three-dimensional   DE-MRI = delayed-enhanced magnetic resonance imaging   MRI = magnetic resonance imaging   PVC = premature ventricular complexes   VT = ventricular tachycardia

Related Articles

Connecting the Dots: The Relevance of Scar in Nonischemic Cardiomyopathy

Alan H. Kadish and Jason C. Rubenstein
J. Am. Coll. Cardiol. 2009 53: 1146-1147. [Full Text] [PDF]

This article has been cited by other articles:

				J. A. White, N. M. Fine, L. Gula, R. Yee, A. Skanes, G. Klein, P. Leong-Sit, H. Warren, T. Thompson, M. Drangova, et al. Utility of Cardiovascular Magnetic Resonance in Identifying Substrate for Malignant Ventricular Arrhythmias Circ Cardiovasc Imaging, January 1, 2012; 5(1): 12 - 20. [Abstract] [Full Text] [PDF]

				T. Sasaki, R. Hansford, M. M. Zviman, A. Kolandaivelu, D. A. Bluemke, R. D. Berger, H. Calkins, H. R. Halperin, and S. Nazarian Quantitative Assessment of Artifacts on Cardiac Magnetic Resonance Imaging of Patients With Pacemakers and Implantable Cardioverter-Defibrillators Circ Cardiovasc Imaging, November 1, 2011; 4(6): 662 - 670. [Abstract] [Full Text] [PDF]

				M. R. Ginks, S. G. Duckett, S. Kapetanakis, J. Bostock, S. Hamid, A. Shetty, Y. Ma, K. S. Rhode, G. S. Carr-White, R. S. Razavi, et al. Multi-site left ventricular pacing as a potential treatment for patients with postero-lateral scar: insights from cardiac magnetic resonance imaging and invasive haemodynamic assessment Europace, November 1, 2011; (2011) eur336v1. [Abstract] [Full Text] [PDF]

				W. G. Stevenson and G. S. Couper A Surgical Option for Ventricular Tachycardia Caused by Nonischemic Cardiomyopathy Circ Arrhythm Electrophysiol, August 1, 2011; 4(4): 429 - 431. [Full Text] [PDF]

				T. Dickfeld, J. Tian, G. Ahmad, A. Jimenez, A. Turgeman, R. Kuk, M. Peters, A. Saliaris, M. Saba, S. Shorofsky, et al. MRI-Guided Ventricular Tachycardia Ablation: Integration of Late Gadolinium-Enhanced 3D Scar in Patients With Implantable Cardioverter-Defibrillators Circ Arrhythm Electrophysiol, April 1, 2011; 4(2): 172 - 184. [Abstract] [Full Text] [PDF]

				N. Mewton, C. Y. Liu, P. Croisille, D. Bluemke, and J. A. C. Lima Assessment of Myocardial Fibrosis With Cardiovascular Magnetic Resonance J. Am. Coll. Cardiol., February 22, 2011; 57(8): 891 - 903. [Abstract] [Full Text] [PDF]

				L. Iles, H. Pfluger, L. Lefkovits, M. J. Butler, P. M. Kistler, D. M. Kaye, and A. J. Taylor Myocardial Fibrosis Predicts Appropriate Device Therapy in Patients With Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death J. Am. Coll. Cardiol., February 15, 2011; 57(7): 821 - 828. [Abstract] [Full Text] [PDF]

				M. D. Hutchinson, E. P. Gerstenfeld, B. Desjardins, R. Bala, M. P. Riley, F. C. Garcia, S. Dixit, D. Lin, W. S. Tzou, J. M. Cooper, et al. Endocardial Unipolar Voltage Mapping to Detect Epicardial Ventricular Tachycardia Substrate in Patients With Nonischemic Left Ventricular Cardiomyopathy Circ Arrhythm Electrophysiol, February 1, 2011; 4(1): 49 - 55. [Abstract] [Full Text] [PDF]

				A. P. Wijnmaalen, R. J. van der Geest, C. F. B. van Huls van Taxis, H.-M. J. Siebelink, L. J. M. Kroft, J. J. Bax, J. H. C. Reiber, M. J. Schalij, and K. Zeppenfeld Head-to-head comparison of contrast-enhanced magnetic resonance imaging and electroanatomical voltage mapping to assess post-infarct scar characteristics in patients with ventricular tachycardias: real-time image integration and reversed registration Eur. Heart J., January 1, 2011; 32(1): 104 - 114. [Abstract] [Full Text] [PDF]

				T. Tanimoto, T. Imanishi, H. Kitabata, N. Nakamura, K. Kimura, T. Yamano, K. Ishibashi, K. Komukai, Y. Ino, S. Takarada, et al. Prevalence and Clinical Significance of Papillary Muscle Infarction Detected by Late Gadolinium-Enhanced Magnetic Resonance Imaging in Patients With ST-Segment Elevation Myocardial Infarction Circulation, November 30, 2010; 122(22): 2281 - 2287. [Abstract] [Full Text] [PDF]

				S. Nakahara, R. Tung, R. J. Ramirez, Y. Michowitz, M. Vaseghi, E. Buch, J. Gima, I. Wiener, A. Mahajan, N. G. Boyle, et al. Characterization of the Arrhythmogenic Substrate in Ischemic and Nonischemic Cardiomyopathy: Implications for Catheter Ablation of Hemodynamically Unstable Ventricular Tachycardia J. Am. Coll. Cardiol., May 25, 2010; 55(21): 2355 - 2365. [Abstract] [Full Text] [PDF]

				H. H. Hsia Epicardial Ventricular Tachycardia Ablation: An Evolution of Needs J. Am. Coll. Cardiol., May 25, 2010; 55(21): 2373 - 2375. [Full Text] [PDF]

				A. Berruezo Complex ventricular arrhythmias: a therapeutic nightmare Heart, May 1, 2010; 96(9): 723 - 728. [Full Text] [PDF]

				D. J. Pennell Cardiovascular Magnetic Resonance Circulation, February 9, 2010; 121(5): 692 - 705. [Full Text] [PDF]

				M. Bertini, V. Delgado, D. W. den Uijl, G. Nucifora, A. C.T. Ng, R. J. van Bommel, C. J. W. Borleffs, G. Boriani, M. J. Schalij, and J. J. Bax Prediction of Cardiac Resynchronization Therapy Response: Value of Calibrated Integrated Backscatter Imaging Circ Cardiovasc Imaging, January 1, 2010; 3(1): 86 - 93. [Abstract] [Full Text] [PDF]

				T. D. Karamitsos, J. M. Francis, S. Myerson, J. B. Selvanayagam, and S. Neubauer The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure J. Am. Coll. Cardiol., October 6, 2009; 54(15): 1407 - 1424. [Abstract] [Full Text] [PDF]

				K. Shivkumar and R. Tung Improving Our Understanding of Epicardial Ventricular Tachycardia in Nonischemic Cardiomyopathy J. Am. Coll. Cardiol., August 25, 2009; 54(9): 809 - 811. [Full Text] [PDF]

				A. H. Kadish and J. C. Rubenstein Connecting the Dots: The Relevance of Scar in Nonischemic Cardiomyopathy J. Am. Coll. Cardiol., March 31, 2009; 53(13): 1146 - 1147. [Full Text] [PDF]