title: Myocardial wall thinning predicts transmural substrate in patients with scar-related ventricular tachycardia.
abstract: Scar-related ventricular tachycardia (VT) arises from specific substrate according to etiology.
  
  
  
  The purpose of this study was to evaluate the relationship between wall thinning (WT) on multidetector computed tomography (MDCT) and local abnormal ventricular activity (LAVA) in patients with ischemic cardiomyopathy (ICM), postmyocarditis (PMC), and dilated cardiomyopathy (DCM).
  
  
  
  Forty-two patients (40 male, age 58 ± 13 years, 22 ICM, 11 PMC, 9 DCM) underwent MDCT before a combined endo-/epicardial VT ablation procedure. WT (<5 mm) and severe wall thinning (SWT) (<2 mm) area on MDCT were compared to the prevalence of endo-/epicardial LAVA during sinus rhythm.
  
  
  
  WT and SWT were found on MDCT in 36 (86%) and 20 (48%) with 42 ± 37 cm2and 26 ± 24 cm2, respectively. SWT was frequently detected in ICM (ICM 77% vs PMC 27% vs DCM 0%, P <.001). LAVA were frequently observed on the endocardium in ICM and on the epicardium in PMC. Endo-/epicardial facing LAVA were frequently found within SWT areas (91% in <2 mm, 9% in 2-5 mm, and 0% in >5 mm, P < .001). In SWT areas, the presence of endocardial LAVA in ICM and epicardial LAVA in PMC predicted opposite facing LAVA with sensitivity and specificity of 78% and 48% and 79% and 98%, respectively. SWT predicted epicardial LAVA in ICM and endocardial LAVA in PMC with sensitivity and specificity of 89% and 100%, and 100% and 100%, respectively.
  
  
  
  SWT is frequently found in ICM and PMC but is not common in DCM. SWT predicts LAVA on the opposite side of the wall (epicardial in ICM and endocardial in PMC), indicating transmural VT substrate. MDCT is useful for identifying VT substrate and helpful for understanding the mechanisms of the location of VT substrate domain.
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France. Electronic address: seigoy722@yahoo.co.jp.
authors.forename: Seigo
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France; Institut Liryc/Equipex Music, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sacher
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Darren A
authors.initials: DA
authors.lastname: Hooks
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Berte
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Sellal
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Frontera
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Nora
authors.initials: N
authors.lastname: Al Jefairi
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Sana
authors.initials: S
authors.lastname: Amraoui
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France; Institut Liryc/Equipex Music, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France; Institut Liryc/Equipex Music, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: Inria, Asclepios Team, Sophia Antipolis, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Sermesant
authors.affiliation: Institut Liryc/Equipex Music, Université de Bordeaux-Inserm U1045, Pessac, France; Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: François
authors.initials: F
authors.lastname: Laurent
authors.affiliation: Institut Liryc/Equipex Music, Université de Bordeaux-Inserm U1045, Pessac, France; Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Montaudon
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France; Institut Liryc/Equipex Music, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France; Institut Liryc/Equipex Music, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France; Institut Liryc/Equipex Music, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.affiliation: Institut Liryc/Equipex Music, Université de Bordeaux-Inserm U1045, Pessac, France; Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Cochet
mesh_terms: D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000150:complications*; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D017202:Myocardial Ischemia / Q000150:complications*; D009205:Myocarditis / Q000150:complications*; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D012680:Sensitivity and Specificity; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000473:pathology / Q000503:physiopathology
keywords: Ablation; Imaging; Multidetector computed tomography; Ventricular tachycardia; Wall thinning