title: Relationship between MDCT-imaged myocardial fat and ventricular tachycardia substrate in arrhythmogenic right ventricular cardiomyopathy.
abstract: BACKGROUND
  Myocardial fibrofatty infiltration is a milieu for ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy (ARVC) and can be depicted as myocardial hypodensity on contrast-enhanced multidetector computed tomography (MDCT) with high spatial and temporal resolution. This study aimed to assess the relationship between MDCT-imaged myocardial fat and VT substrate in ARVC.
  
  
  RESULTS
  We studied 16 patients with ARVC who underwent ablation and preprocedural MDCT. High-resolution imaging data were processed and registered to high-density endocardial and epicardial maps in sinus rhythm on 3-dimensional electroanatomic mapping (3D-EAM) (626±335 and 575±279 points/map, respectively). Analysis of the locations of low-voltage and fat segmentation included the following endocardial and epicardial regions: apex, mid (anterior, lateral, inferior), and basal (anterior, lateral, inferior). The location of local abnormal ventricular activities (LAVA) was compared with fat distribution. RV myocardial fat was successfully segmented and integrated with 3D-EAM in all patients. The κ agreement test demonstrated a good concordance between the epicardial low voltage and fat (κ=0.69, 95% CI 0.54 to 0.84), but fair concordance with the endocardium (κ=0.41, 95% CI 0.27 to 0.56). The majority of LAVA (520/653 [80%]) were located within the RV fat segmentation, of which 90% were not farther than 20 mm from its border. Registration of MDCT allowed direct visualization of the coronary arteries, thus avoiding coronary damage during epicardial radiofrequency delivery.
  
  
  CONCLUSIONS
  The integration of MDCT-imaged myocardial fat with 3D-EAM provides valuable information on the extent and localization of VT substrate and demonstrates ablation targets clustering in its border region.
authors.affiliation: Institut LYRIC, Equipex MUSIC, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (Y.K., F.S., A.D., M.D., N.D., A.S., M.M., F.L., H., M.H., P.J., H.C.).
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Germany (A.J., H.L., C.I.P., R.W., T.A., G.P.).
authors.forename: Amir
authors.initials: A
authors.lastname: Jadidi
authors.affiliation: Institut LYRIC, Equipex MUSIC, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (Y.K., F.S., A.D., M.D., N.D., A.S., M.M., F.L., H., M.H., P.J., H.C.).
authors.forename: Frederic
authors.initials: F
authors.lastname: Sacher
authors.affiliation: Institut LYRIC, Equipex MUSIC, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (Y.K., F.S., A.D., M.D., N.D., A.S., M.M., F.L., H., M.H., P.J., H.C.).
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.affiliation: Institut LYRIC, Equipex MUSIC, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (Y.K., F.S., A.D., M.D., N.D., A.S., M.M., F.L., H., M.H., P.J., H.C.).
authors.forename: Matthew
authors.initials: M
authors.lastname: Daly
authors.affiliation: Institut LYRIC, Equipex MUSIC, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (Y.K., F.S., A.D., M.D., N.D., A.S., M.M., F.L., H., M.H., P.J., H.C.).
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: Institut LYRIC, Equipex MUSIC, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (Y.K., F.S., A.D., M.D., N.D., A.S., M.M., F.L., H., M.H., P.J., H.C.).
authors.forename: Ashok
authors.initials: A
authors.lastname: Shah
authors.affiliation: University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Germany (A.J., H.L., C.I.P., R.W., T.A., G.P.).
authors.forename: Heiko
authors.initials: H
authors.lastname: Lehrmann
authors.affiliation: University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Germany (A.J., H.L., C.I.P., R.W., T.A., G.P.).
authors.forename: Chan-Il
authors.initials: CI
authors.lastname: Park
authors.affiliation: University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Germany (A.J., H.L., C.I.P., R.W., T.A., G.P.).
authors.forename: Reinhold
authors.initials: R
authors.lastname: Weber
authors.affiliation: University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Germany (A.J., H.L., C.I.P., R.W., T.A., G.P.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Arentz
authors.affiliation: University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Germany (A.J., H.L., C.I.P., R.W., T.A., G.P.).
authors.forename: Gregor
authors.initials: G
authors.lastname: Pache
authors.affiliation: INRIA Sophia Antipolis, Sophia Antipolis, France (M.S., N.A.).
authors.forename: Maxime
authors.initials: M
authors.lastname: Sermesant
authors.affiliation: INRIA Sophia Antipolis, Sophia Antipolis, France (M.S., N.A.).
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ayache
authors.affiliation: St. Jude Medical, St. Paul, MN (J.R.).
authors.forename: Jatin
authors.initials: J
authors.lastname: Relan
authors.affiliation: Institut LYRIC, Equipex MUSIC, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (Y.K., F.S., A.D., M.D., N.D., A.S., M.M., F.L., H., M.H., P.J., H.C.).
authors.forename: Michel
authors.initials: M
authors.lastname: Montaudon
authors.affiliation: Institut LYRIC, Equipex MUSIC, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (Y.K., F.S., A.D., M.D., N.D., A.S., M.M., F.L., H., M.H., P.J., H.C.).
authors.forename: François
authors.initials: F
authors.lastname: Laurent
authors.affiliation: Institut LYRIC, Equipex MUSIC, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (Y.K., F.S., A.D., M.D., N.D., A.S., M.M., F.L., H., M.H., P.J., H.C.).
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: Institut LYRIC, Equipex MUSIC, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (Y.K., F.S., A.D., M.D., N.D., A.S., M.M., F.L., H., M.H., P.J., H.C.).
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: Institut LYRIC, Equipex MUSIC, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (Y.K., F.S., A.D., M.D., N.D., A.S., M.M., F.L., H., M.H., P.J., H.C.).
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.affiliation: Institut LYRIC, Equipex MUSIC, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (Y.K., F.S., A.D., M.D., N.D., A.S., M.M., F.L., H., M.H., P.J., H.C.).
authors.forename: Hubert
authors.initials: H
authors.lastname: Cochet
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017115:Catheter Ablation; D056149:Epicardial Mapping; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009206:Myocardium; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult
keywords: ablation; arrhythmia; arrhythmogenic right ventricular cardiomyopathy; electroanatomic mapping; imaging; ventricular tachycardia
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