Volume 13, Issue 1, Pages (January 2016)

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Abnormal epicardial electrophysiologic substrate in patients with early repolarization pattern and reduced left ventricular systolic function: A report.

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Volume 13, Issue 1, Pages 85-95 (January 2016) Infarct transmurality as a criterion for first-line endo-epicardial substrate–guided ventricular tachycardia ablation in ischemic cardiomyopathy Juan Acosta, MD, Juan Fernández-Armenta, MD, Diego Penela, MD, David Andreu, MSc, PhD, Roger Borras, MSc, Francesca Vassanelli, MD, Viatcheslav Korshunov, MD, Rosario J. Perea, MD, PhD, Teresa M. de Caralt, MD, PhD, Jose T. Ortiz, MD, PhD, Guillermina Fita, MD, PhD, Marta Sitges, MD, PhD, Josep Brugada, MD, PhD, Lluis Mont, MD, PhD, Antonio Berruezo, MD, PhD Heart Rhythm Volume 13, Issue 1, Pages 85-95 (January 2016) DOI: 10.1016/j.hrthm.2015.07.010 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Infarct transmurality criteria for anterior myocardial infarction. A: Magnetic resonance images showing an apical left ventricular aneurysm and a transmural anteroseptoapical myocardial hyperenhancement (yellow arrow). B: Echocardiography: 4-chamber view showing an aneurismatic left ventricle and apical wall thinning. C: Electroanatomic bipolar maps (left anterior oblique views) of endocardial and epicardial left ventricular surface, showing low-voltage areas in segments that exhibited transmurality criteria in both contrast-enhanced cardiac magnetic resonance imaging and echocardiography. Electrograms with sequential activation pattern can be observed in the endocardium and epicardium. LVa = left ventricular apex. Heart Rhythm 2016 13, 85-95DOI: (10.1016/j.hrthm.2015.07.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Infarct transmurality criteria for inferoposterior myocardial infarction. A: Magnetic resonance images showing a transmural inferoposterior myocardial hyperenhancement (yellow arrows). B: Computed tomography showing basal inferoposterior wall thinning. C: Electroanatomic bipolar maps (left anterior oblique views) of endocardial and epicardial left ventricular surface, showing low-voltage areas in segments that exhibited transmurality criteria in both contrast-enhanced cardiac magnetic resonance imaging and computed tomography. Electrograms with sequential activation pattern can be observed in the endocardium and epicardium. Heart Rhythm 2016 13, 85-95DOI: (10.1016/j.hrthm.2015.07.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Study flowchart. MI = myocardial infarction; VT = ventricular tachycardia. Heart Rhythm 2016 13, 85-95DOI: (10.1016/j.hrthm.2015.07.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 4 Kaplan-Meier curve for the end point of ventricular tachycardia recurrence according to infarct transmurality and type of approach. Group 1 = patients with subendocardial infarction and endocardial approach; Group 2 = patients with transmural infarction and endo-epicardial approach; Group 3 = patients with transmural infarction and endocardial approach; VT = ventricular tachycardia. Heart Rhythm 2016 13, 85-95DOI: (10.1016/j.hrthm.2015.07.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions