Ring-Like Scar Architecture and Arrhythmic Outcomes of Patients With Nondilated Left Ventricular Cardiomyopathy Treated With Ventricular Tachycardia Ablation.

Authors

Raimondo Pittorru, Nicola Pierucci, Deni Kukavica, Pranav Bhagirath, Thomas Rosseel, Mariona Regany-Closa, José T Ortiz-Perez, Susanna Prat-Gonzalez, Anna Victor-Baldomà, Jean Baptiste Guichard, Federico Migliore, Jose-Maria Tolosana, Eduard Guasch, Lluis Mont, Josep Brugada, Elena Arbelo, Marta Sitges, Ana Garcia-Alvarez, Andreu Porta-Sánchez, Ivo Roca-Luque

Published in

JACC. Clinical electrophysiology. Aug 26, 2026. Epub Aug 26, 2026.

Abstract

Nondilated left ventricular cardiomyopathy (NDLVC) is characterized by an elevated arrhythmic burden and frequent presence of ring-like late gadolinium enhancement (RL-LGE) pattern. However, the arrhythmic substrate and outcomes after ventricular tachycardia (VT) ablations remain undefined.
This study sought to characterize the arrhythmogenic substrate using postprocessed cardiac magnetic resonance and assess VT recurrence after ablation in patients with NDLVC.
Consecutive patients with NDLVC undergoing VT ablation at the Hospital Clínic of Barcelona were included.
Thirty-seven patients were included (age 44 years [IQR: 39-55]; 78% male; left ventricular ejection fraction 45% [IQR: 40-52]). RL-LGE was observed in 21 of 37 (57%) patients. Compared with patients without it, patients with RL-LGE had lower left ventricular ejection fraction (40% [38% to 45%] vs 51% [49% to 55%], P < 0.0001), greater scar burden (16.2% [12.7% to 20.0%] vs 5.4% [5.0% to 6.0%], P < 0.0001), larger number of arrhythmogenic conducting channels (3 [2-4] vs 1 [1-2], P < 0.0001), and longer conducting channels (34 mm [29-38 mm] vs 12 mm [10-14 mm], P < 0.0001). Over a median of 3 years of follow-up, 30% of patients had VT recurrence with event rate of 10.2%/year. Dense scar (HR: 1.13, per 1% increment; 95% CI: 1.05-1.22; P = 0.002) and borderzone scar burden (HR: 1.27; 95% CI: 1.11-1.45; P = 0.001), number (HR: 2.35; 95% CI: 1.42-3.91; P = 0.001) and the length of conducting channels (HR: 1.04 per 1 mm increase; 95% CI: 1.01-1.06; P = 0.006) were associated with VT recurrence. The adjusted risk of VT recurrence was 24-fold higher in patients with RL-LGE (HR: 24.0; 95% CI: 2.8-207.1; P = 0.004).
RL-LGE identifies patients with NDLVC with a more complex arrhythmogenic substrate and a poorer outcome after VT ablation.

PMID:
42714370
Bibliographic data and abstract were imported from PubMed on 09 Sep 2026.

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