Isolated septal substrate for ventricular tachycardia in nonischemic dilated cardiomyopathy: Incidence, characterization, and implications

Haris M. Haqqani, Cory M. Tschabrunn, Wendy S. Tzou, Sanjay Dixit, Joshua M. Cooper, Michael P. Riley, David Lin, Mathew D. Hutchinson, Fermin C. Garcia, Rupa Bala, Ralph J. Verdino, David J. Callans, Edward P. Gerstenfeld, Erica S. Zado, Francis E. Marchlinski

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Background: The substrate for ventricular tachycardia (VT) in nonischemic cardiomyopathy (NICM) has a predilection for the basolateral left ventricle with right bundle branch block VT morphology. Objective: The purpose of this study was to describe a unique group of NICM patients with septal VT substrate. Methods: Between 1999 and 2010, 31 (11.6%) of 266 patients with NICM undergoing VT ablation had septal substrate and no lateral involvement. Mean age was 59 ± 12 years, and ejection fraction was 30% ± 14%. Eight patients had heart block. Results: Cardiac magnetic resonance showed septal delayed enhancement in 8 of 9 patients. Electroanatomic mapping demonstrated bipolar low voltage (2 precordial transition pattern break in 17% suggesting periseptal exit. After substrate and targeted VT ablation, no VT was inducible in 66% and no "clinical targeted" VT in 86%. Over a mean follow-up of 20 ± 28 months, VT recurred in 10 (32%) patients. Conclusion: Isolated septal VT substrate is uncommon in NICM. Biventricular low-voltage zones extending from the basal septum are characteristic, but septal scarring can be entirely intramural as evidenced by unipolar/bipolar electrograms and imaging. Multiple unmappable morphologies are the rule, often requiring several procedures aggressively targeting the septal substrate to achieve moderate long-term VT control.

Original languageEnglish (US)
Pages (from-to)1169-1176
Number of pages8
JournalHeart Rhythm
Volume8
Issue number8
DOIs
StatePublished - Aug 2011
Externally publishedYes

Fingerprint

Dilated Cardiomyopathy
Ventricular Tachycardia
Incidence
Cardiomyopathies
Heart Block
Bundle-Branch Block
Heart Ventricles
Cicatrix
Magnetic Resonance Spectroscopy

Keywords

  • Cardiomyopathy
  • Catheter ablation
  • Electroanatomic mapping
  • Heart failure
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Haqqani, H. M., Tschabrunn, C. M., Tzou, W. S., Dixit, S., Cooper, J. M., Riley, M. P., ... Marchlinski, F. E. (2011). Isolated septal substrate for ventricular tachycardia in nonischemic dilated cardiomyopathy: Incidence, characterization, and implications. Heart Rhythm, 8(8), 1169-1176. https://doi.org/10.1016/j.hrthm.2011.03.008

Isolated septal substrate for ventricular tachycardia in nonischemic dilated cardiomyopathy : Incidence, characterization, and implications. / Haqqani, Haris M.; Tschabrunn, Cory M.; Tzou, Wendy S.; Dixit, Sanjay; Cooper, Joshua M.; Riley, Michael P.; Lin, David; Hutchinson, Mathew D.; Garcia, Fermin C.; Bala, Rupa; Verdino, Ralph J.; Callans, David J.; Gerstenfeld, Edward P.; Zado, Erica S.; Marchlinski, Francis E.

In: Heart Rhythm, Vol. 8, No. 8, 08.2011, p. 1169-1176.

Research output: Contribution to journalArticle

Haqqani, HM, Tschabrunn, CM, Tzou, WS, Dixit, S, Cooper, JM, Riley, MP, Lin, D, Hutchinson, MD, Garcia, FC, Bala, R, Verdino, RJ, Callans, DJ, Gerstenfeld, EP, Zado, ES & Marchlinski, FE 2011, 'Isolated septal substrate for ventricular tachycardia in nonischemic dilated cardiomyopathy: Incidence, characterization, and implications', Heart Rhythm, vol. 8, no. 8, pp. 1169-1176. https://doi.org/10.1016/j.hrthm.2011.03.008
Haqqani, Haris M. ; Tschabrunn, Cory M. ; Tzou, Wendy S. ; Dixit, Sanjay ; Cooper, Joshua M. ; Riley, Michael P. ; Lin, David ; Hutchinson, Mathew D. ; Garcia, Fermin C. ; Bala, Rupa ; Verdino, Ralph J. ; Callans, David J. ; Gerstenfeld, Edward P. ; Zado, Erica S. ; Marchlinski, Francis E. / Isolated septal substrate for ventricular tachycardia in nonischemic dilated cardiomyopathy : Incidence, characterization, and implications. In: Heart Rhythm. 2011 ; Vol. 8, No. 8. pp. 1169-1176.
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abstract = "Background: The substrate for ventricular tachycardia (VT) in nonischemic cardiomyopathy (NICM) has a predilection for the basolateral left ventricle with right bundle branch block VT morphology. Objective: The purpose of this study was to describe a unique group of NICM patients with septal VT substrate. Methods: Between 1999 and 2010, 31 (11.6{\%}) of 266 patients with NICM undergoing VT ablation had septal substrate and no lateral involvement. Mean age was 59 ± 12 years, and ejection fraction was 30{\%} ± 14{\%}. Eight patients had heart block. Results: Cardiac magnetic resonance showed septal delayed enhancement in 8 of 9 patients. Electroanatomic mapping demonstrated bipolar low voltage (2 precordial transition pattern break in 17{\%} suggesting periseptal exit. After substrate and targeted VT ablation, no VT was inducible in 66{\%} and no {"}clinical targeted{"} VT in 86{\%}. Over a mean follow-up of 20 ± 28 months, VT recurred in 10 (32{\%}) patients. Conclusion: Isolated septal VT substrate is uncommon in NICM. Biventricular low-voltage zones extending from the basal septum are characteristic, but septal scarring can be entirely intramural as evidenced by unipolar/bipolar electrograms and imaging. Multiple unmappable morphologies are the rule, often requiring several procedures aggressively targeting the septal substrate to achieve moderate long-term VT control.",
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T1 - Isolated septal substrate for ventricular tachycardia in nonischemic dilated cardiomyopathy

T2 - Incidence, characterization, and implications

AU - Haqqani, Haris M.

AU - Tschabrunn, Cory M.

AU - Tzou, Wendy S.

AU - Dixit, Sanjay

AU - Cooper, Joshua M.

AU - Riley, Michael P.

AU - Lin, David

AU - Hutchinson, Mathew D.

AU - Garcia, Fermin C.

AU - Bala, Rupa

AU - Verdino, Ralph J.

AU - Callans, David J.

AU - Gerstenfeld, Edward P.

AU - Zado, Erica S.

AU - Marchlinski, Francis E.

PY - 2011/8

Y1 - 2011/8

N2 - Background: The substrate for ventricular tachycardia (VT) in nonischemic cardiomyopathy (NICM) has a predilection for the basolateral left ventricle with right bundle branch block VT morphology. Objective: The purpose of this study was to describe a unique group of NICM patients with septal VT substrate. Methods: Between 1999 and 2010, 31 (11.6%) of 266 patients with NICM undergoing VT ablation had septal substrate and no lateral involvement. Mean age was 59 ± 12 years, and ejection fraction was 30% ± 14%. Eight patients had heart block. Results: Cardiac magnetic resonance showed septal delayed enhancement in 8 of 9 patients. Electroanatomic mapping demonstrated bipolar low voltage (2 precordial transition pattern break in 17% suggesting periseptal exit. After substrate and targeted VT ablation, no VT was inducible in 66% and no "clinical targeted" VT in 86%. Over a mean follow-up of 20 ± 28 months, VT recurred in 10 (32%) patients. Conclusion: Isolated septal VT substrate is uncommon in NICM. Biventricular low-voltage zones extending from the basal septum are characteristic, but septal scarring can be entirely intramural as evidenced by unipolar/bipolar electrograms and imaging. Multiple unmappable morphologies are the rule, often requiring several procedures aggressively targeting the septal substrate to achieve moderate long-term VT control.

AB - Background: The substrate for ventricular tachycardia (VT) in nonischemic cardiomyopathy (NICM) has a predilection for the basolateral left ventricle with right bundle branch block VT morphology. Objective: The purpose of this study was to describe a unique group of NICM patients with septal VT substrate. Methods: Between 1999 and 2010, 31 (11.6%) of 266 patients with NICM undergoing VT ablation had septal substrate and no lateral involvement. Mean age was 59 ± 12 years, and ejection fraction was 30% ± 14%. Eight patients had heart block. Results: Cardiac magnetic resonance showed septal delayed enhancement in 8 of 9 patients. Electroanatomic mapping demonstrated bipolar low voltage (2 precordial transition pattern break in 17% suggesting periseptal exit. After substrate and targeted VT ablation, no VT was inducible in 66% and no "clinical targeted" VT in 86%. Over a mean follow-up of 20 ± 28 months, VT recurred in 10 (32%) patients. Conclusion: Isolated septal VT substrate is uncommon in NICM. Biventricular low-voltage zones extending from the basal septum are characteristic, but septal scarring can be entirely intramural as evidenced by unipolar/bipolar electrograms and imaging. Multiple unmappable morphologies are the rule, often requiring several procedures aggressively targeting the septal substrate to achieve moderate long-term VT control.

KW - Cardiomyopathy

KW - Catheter ablation

KW - Electroanatomic mapping

KW - Heart failure

KW - Ventricular tachycardia

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