Lipomatous Metaplasia Is Associated With Ventricular Tachycardia Recurrence Following Ablation in Patients With Nonischemic Cardiomyopathy

Lingyu Xu; Mirmilad Khoshknab; Juwann Moss; Ronald D Berger; Jonathan Chrispin; David Callans; Francis E Marchlinski; Stefan L Zimmerman; Yuchi Han; Natalia Trayanova; Benoit Desjardins; Saman Nazarian

doi:10.1016/j.jacep.2024.02.024

Lipomatous Metaplasia Is Associated With Ventricular Tachycardia Recurrence Following Ablation in Patients With Nonischemic Cardiomyopathy

JACC Clin Electrophysiol. 2024 Apr 17:S2405-500X(24)00170-1. doi: 10.1016/j.jacep.2024.02.024. Online ahead of print.

Affiliations

¹ Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
² Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
³ Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA.
⁴ Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.
⁵ Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
⁶ Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. Electronic address: saman.nazarian@pennmedicine.upenn.edu.

PMID: 38703163
DOI: 10.1016/j.jacep.2024.02.024

Abstract

Background: Ventricular tachycardia (VT) recurrence rates remain high following ablation among patients with nonischemic cardiomyopathy (NICM).

Objectives: This study sought to define the prevalence of lipomatous metaplasia (LM) in patients with NICM and VT and its association with postablation VT recurrence.

Methods: From patients who had ablation of left ventricular VT, we retrospectively identified 113 consecutive NICM patients with preprocedural contrast-enhanced cardiac computed tomography (CECT), from which LM was segmented. Nested within this cohort were 62 patients that prospectively underwent CECT and cardiac magnetic resonance from which myocardial border zone and dense late gadolinium enhancement (LGE) were segmented. A control arm of 30 NICM patients without VT with CECT was identified.

Results: LM was identified among 57% of control patients without VT vs 83% of patients without VT recurrence and 100% of patients with VT recurrence following ablation. In multivariable analyses, LM extent was the only independent predictor of VT recurrence, with an adjusted HR per 1-g LM increase of 1.1 (P < 0.001). Patients with LM extent ≥2.5 g had 4.9-fold higher hazard of VT recurrence than those with LM <2.5 g (P < 0.001). In the nested cohort with 32 VT recurrences, LM extent was independently associated with VT recurrence after adjustment for border zone and LGE extent (HR per 1 g increase: 1.1; P = 0.036).

Conclusions: Myocardial LM is prevalent in patients with NICM of a variety of etiologies, and its extent is associated with postablation VT recurrence independent of the degree of fibrosis.

Keywords: lipomatous metaplasia; nonischemic cardiomyopathy; ventricular tachycardia.