Isolated late activation detected by magnetocardiography predicts future lethal ventricular arrhythmic events in patients with arrhythmogenic right ventricular cardiomyopathy

Yoshitaka Kimura, Hiroshi Takaki, Yuko Y. Inoue, Yasutaka Oguchi, Tomomi Nagayama, Takahiro Nakashima, Shoji Kawakami, Satoshi Nagase, Takashi Noda, Takeshi Aiba, Wataru Shimizu, Shiro Kamakura, Masaru Sugimachi, Satoshi Yasuda, Hiroaki Shimokawa, Kengo Kusano

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

Background: Risk stratification of ventricular arrhythmias is vital to the optimal management in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). We hypothesized that 64-channel magnetocardiography (MCG) would be useful to detect isolated late activation (ILA) by overcoming the limitations of conventional noninvasive predictors of ventricular tachyarrhythmias, including epsilon waves, late potential (LP), and right ventricular ejection fraction (RVEF), in ARVC patients. Methods and Results: We evaluated ILA on MCG, defined as discrete activations re-emerging after the decay of main RV activation (%magnitude >5%), and conventional noninvasive predictors of ventricular tachyarrhythmias (epsilon waves, LP, and RVEF) in 40 patients with ARVC. ILA was noted in 24 (60%) patients. Most ILAs were found in RV lateral or inferior areas (17/24, 71%). We defined “delayed ILA” as ILA in which the conduction delay exceeded its median (50 ms). During a median follow-up of 42.5 months, major arrhythmic events (MAEs: 1 sudden cardiac death, 3 sustained ventricular tachycardias, and 4 appropriate implantable cardioverter defibrillator discharges) occurred more frequently in patients with delayed ILA (6/12) than in those without (2/28; log-rank: P=0.004). Cox regression analysis identified delayed ILA as the only independent predictor of MAEs (hazard ratio 7.63, 95% confidence interval 1.72–52.6, P=0.007), and other noninvasive parameters were not significant predictors. Conclusions: MCG is useful to identify ARVC patients at high risk of future lethal ventricular arrhythmias.

Original languageEnglish
Pages (from-to)78-86
Number of pages9
JournalCirculation Journal
Volume82
Issue number1
DOIs
Publication statusPublished - 2018

Keywords

  • Epsilon waves
  • Late potential
  • Risk stratification
  • Sudden cardiac death
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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