Magnetic resonance imaging abnormalities in the basal interventricular septum of patients with left ventricular outflow tract arrhythmias

• Published in: Journal of cardiovascular electrophysiology 2019-07, Vol.30 (7), p.1042-1052
• Main Authors: Reithmann, Christopher, Kling, Theresia, Herkommer, Bernhard, Fiek, Michael, Ulbrich, Michael
• Format: Article
• Language: English
• Subjects: Ablation; Arrhythmia; Cardiac arrhythmia; Catheters; delayed enhancement (DE); Electrocardiography; Fibrosis; Heart; left ventricular outflow tract (LVOT); Magnetic resonance imaging; magnetic resonance imaging (MRI); Medical instruments; NMR; Nuclear magnetic resonance; premature ventricular contraction (PVC); Resonance; Septum; Substrates; Tachycardia; Ventricle; ventricular tachycardia (VT)
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.13951

Introduction Concealed structural abnormalities were detected by delayed enhancement ‐ magnetic resonance imaging (DE‐MRI) in patients with apparently idiopathic tachycardia of left ventricular (LV) origin. Basal septal fibrosis was evaluated as a potential arrhythmia substrate in patients with left ventricular outflow tract (LVOT) arrhythmias. Methods and Results A total of 22 patients with LVOT arrhythmias, including frequent monomorphic premature ventricular complexes (PVCs) in 15 patients and ventricular tachycardia (VT) in 7 patients, underwent catheter ablation and DE‐MRI. A total of 19 patients with frequent PVCs and 17 patients with idiopathic VT of other origin served as a control group. Basal septal intramural fibrosis as thin strip‐shaped intramyocardial DE or as marked intramyocardial DE involving >25% of wall thickness was detected more frequently in patients with LVOT arrhythmias (41% and 32%) than in patients with non LVOT arrhythmias (14% and 3%). After successful ablation, 4/16 patients with basal septal intramural fibrosis and LVOT PVCs (n = 3) or LVOT VT (n = 1) compared with no patient without basal septal fibrosis experienced episodes of sustained VT with similar or different QRS morphology resulting in ICD therapy in three patients. Follow‐up DE‐MRI after PVC ablation (17 ± 7 months) revealed an increase in LV ejection fraction from 49 ± 5% to 56 ± 5% (n = 9) but the amount of septal DE remained unchanged. Conclusions Basal septal intramural fibrosis may serve as the arrhythmia substrate in a substantial part of patients with premature ventricular complexes (PVCs) and VT originating from the LVOT and identifies patients with continued risk for VT recurrence after initially successful ablation of LVOT arrhythmias.