title: Scar progression in patients with nonischemic cardiomyopathy and ventricular arrhythmias.
abstract: BACKGROUND
  Disease progression in patients with nonischemic cardiomyopathy (NICM) is poorly understood.
  
  
  OBJECTIVE
  To assess left ventricular (LV) scar progression and dilatation by using endocardial electroanatomic mapping.
  
  
  METHODS
  We studied 13 patients with NICM and recurrent ventricular tachycardia. Two detailed sinus rhythm endocardial voltage maps (265 ± 122 points/map) were obtained after a mean of 32 months (range 9-77 months). The scar area, defined by low bipolar (BI; <1.5 mV) and unipolar (UNI; <8.3 mV) endocardial voltage, and the LV volume were measured and compared. A scar difference of >6% of the LV surface and an increase in LV volume of ≥20 mL were considered beyond measurement error.
  
  
  RESULTS
  Six (46%) patients had an increase in scar area beyond boundaries of prior ablation. Five patients had an increase in UNI and 1 patient had an increase in both BI and UNI areas. The increase in BI area represented 16% and the increase in UNI area represented 6.5%-46.2% of the LV surface. A significant decrease in LV ejection fraction was found only in patients with scar progression (from 39% ± 8% to 32% ± 8%; P = .003). LV dilation (LV volume increase ranging between 9% and 23%) was noted in 3 patients, all of whom had scar progression.
  
  
  CONCLUSIONS
  Progressive scarring with an increase in the area of UNI and less commonly BI electrogram abnormality is seen in 46% of the patients with NICM and ventricular tachycardia and is associated with LV dilatation and decrease in LV ejection fraction. The prominent UNI abnormality suggests predominantly midmyocardial or epicardial scarring.
authors.affiliation: Division of Cardiac Electrophysiology, Department of Cardiology, University Hospital Linköping, Linköping, Sweden.
authors.forename: Ioan
authors.initials: I
authors.lastname: Liuba
authors.affiliation: The Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.affiliation: The Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Riley
authors.affiliation: The Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.affiliation: The Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.affiliation: The Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Fermin C
authors.initials: FC
authors.lastname: Garcia
authors.affiliation: The Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.affiliation: The Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Supple
authors.affiliation: The Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.affiliation: The Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.affiliation: The Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Fabien
authors.initials: F
authors.lastname: Squara
authors.affiliation: The Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.affiliation: The Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: francis.marchlinski@uphs.upenn.edu.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D000328:Adult; D000368:Aged; D018780:Body Surface Potential Mapping / Q000379:methods*; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D017115:Catheter Ablation; D002921:Cicatrix / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D018450:Disease Progression; D056149:Epicardial Mapping / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis* / Q000628:therapy
keywords: Ablation; Cardiac resynchronization therapy; Cardiomyopathy; Electrograms; Mapping; Ventricular tachycardia