Speckle tracking echocardiography as a predictor of location of ablation sites in candidates to catheter ablation for recurrent ventricular tachycardia

Abstract Background Preoperative imaging is essential before a ventricular tachycardia (VT) ablation procedure, to improve operative outcomes and reduce procedural times. Although MRI is the gold standard, it has several limitations, including patient compliance, possible presence of non-MRI-compatible devices, and long acquisition time. Speckle tracking echocardiography (STE) is a reliable and appealing technique that quantifies regional and global myocardial deformation, as well as layer-specific (endo-, mid- and epicardial) longitudinal strain, without MRI limitations. Purpose This study aimed to evaluate the efficacy of STE in predicting VT ablation sites. Methods In this study, we compared the bull’s eye segmentation of the left ventricle, global and layer-specific, obtained with STE (TomTec Arena), to investigate whether echocardiography can predict the areas of scar and late potential, as identified by electroanatomic mapping (EnSite X mapping, HD Grid mapping catheter, Abbott). Strain analysis and electroanatomic mapping data were matched segment-by-segment to obtain pairs of endocardial strain and bipolar substrate maps, as well as pairs of midmyocardial/epicardial strain and unipolar substrate maps. Results Twenty-three consecutive patients with an indication for catheter ablation for recurrent VT were enrolled. All patients were being treated with beta-blockers, 52% were taking amiodarone, and only 2 patients were on mexiletine. A total of 1170 pairs of bull’s eye segments were available for analysis. A binary logistic mixed-effects model was used to predict the presence of electroanatomical scar based on strain echocardiography data, to account for interpatient variability. The study findings highlighted a close correlation between the bipolar map and endocardial strain values, and between the unipolar map and midmyocardial strain values. Progressively higher (less negative) values of endocardial strain proved predictive of bipolar electroanatomical scar, with an increase in the odds ratio of bipolar electroanatomical scar equal to 6.2% (95% confidence interval 2.5%-10%) for each unit increase in strain values. Similarly, progressively higher values of midmyocardial strain were predictive of unipolar electroanatomical scar, with an increase in the odds ratio of unipolar electroanatomical scar equal to 6.2% (95% confidence interval 1.2%-11.4%) for each unit increase in strain values. Conclusions The data from our study showed an anatomical correspondence between the areas of low potential identified by electroanatomical mapping and the areas of anomalous longitudinal strain. In particular, the endocardial strain correlates with the bipolar map, and the meso-epicardial strain correlates with the unipolar map. These data may prove useful in the appropriate planning of the procedure in patients with an indication for catheter ablation in the context of recurrent VT.