Correlation of extent of left ventricular endocardial unipolar low-voltage zones with ventricular tachycardia in nonischemic cardiomyopathy

Deep Chandh Raja; Jenish Shroff; Anugrah Nair; Sreevilasam P Abhilash; Lukah Q Tuan; Abhinav Mehta; Walter P Abhayaratna; Prashanthan Sanders; David S Frankel; Francis E Marchlinski; Rajeev Kumar Pathak

doi:10.1016/j.hrthm.2024.04.065

Correlation of extent of left ventricular endocardial unipolar low-voltage zones with ventricular tachycardia in nonischemic cardiomyopathy

Heart Rhythm. 2024 Apr 16:S1547-5271(24)02392-0. doi: 10.1016/j.hrthm.2024.04.065. Online ahead of print.

Affiliations

¹ The Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm Centre, Australian Capital Territory, Australia.
² The Australian National University, Australian Capital Territory, Australia.
³ Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
⁴ Section of Cardiac Electrophysiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
⁵ The Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm Centre, Australian Capital Territory, Australia. Electronic address: rajeev.pathak@canberraheartrhythm.com.au.

PMID: 38636932
DOI: 10.1016/j.hrthm.2024.04.065

Abstract

Background: Endocardial electrogram (EGM) characteristics in nonischemic cardiomyopathy (NICM) have not been explored adequately for prognostication.

Objective: We aimed to study correlation of bipolar and unipolar EGM characteristics with left ventricular ejection fraction (LVEF) and ventricular tachycardia (VT) in NICM.

Methods: Electroanatomic mapping of the left ventricle was performed. EGM characteristics were correlated with LVEF. Differences between groups with and without VT and predictors of VT were studied.

Results: In 43 patients, unipolar EGM variables had better correlation with baseline LVEF than bipolar EGM variables: unipolar voltage (r = +0.36), peak negative unipolar voltage (r = -0.42), peak positive unipolar voltage (r = +0.38), and percentage area of unipolar low-voltage zone (LVZ; r = -0.41). Global mean unipolar voltage (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.2-0.8), extent of unipolar LVZ (HR, 1.6; 95% CI, 1.1-2.3), and percentage area of unipolar LVZ (HR, 1.6; 95% CI, 1.1-2.3) were significant predictors of VT. For classification of patients with VT, extent of unipolar LVZ had an area under the curve of 0.82 (95% CI, 0.69-0.95; P < .001), and percentage area of unipolar LVZ had an area under the curve of 0.83 (95% CI, 0.71-0.96; P = .01). Cutoff of >3 segments for extent of unipolar LVZ had the best diagnostic accuracy (sensitivity, 90%; specificity, 67%) and cutoff of 33% for percentage area of unipolar LVZ had the best diagnostic accuracy (sensitivity, 95%; specificity, 60%) for VT.

Conclusion: In NICM, extent and percentage area of unipolar LVZs are significant predictors of VT. Cutoffs of >3 segments of unipolar LVZ and >33% area of unipolar LVZ have good diagnostic accuracies for association with VT.

Keywords: Bipolar voltage; Electroanatomic mapping; Low-voltage zone; Nonischemic cardiomyopathy; Unipolar voltage; Ventricular tachycardia.