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06.03.2019 | Original Article | Ausgabe 4/2019

Pediatric Cardiology 4/2019

Computational Identification of Ventricular Arrhythmia Risk in Pediatric Myocarditis

Zeitschrift:
Pediatric Cardiology > Ausgabe 4/2019
Autoren:
Mark J. Cartoski, Plamen P. Nikolov, Adityo Prakosa, Patrick M. Boyle, Philip J. Spevak, Natalia A. Trayanova
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00246-019-02082-7) contains supplementary material, which is available to authorized users.

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Abstract

Children with myocarditis have increased risk of ventricular tachycardia (VT) due to myocardial inflammation and remodeling. There is currently no accepted method for VT risk stratification in this population. We hypothesized that personalized models developed from cardiac late gadolinium enhancement magnetic resonance imaging (LGE-MRI) could determine VT risk in patients with myocarditis using a previously-validated protocol. Personalized three-dimensional computational cardiac models were reconstructed from LGE-MRI scans of 12 patients diagnosed with myocarditis. Four patients with clinical VT and eight patients without VT were included in this retrospective analysis. In each model, we incorporated a personalized spatial distribution of fibrosis and myocardial fiber orientations. Then, VT inducibility was assessed in each model by pacing rapidly from 26 sites distributed throughout both ventricles. Sustained reentrant VT was induced from multiple pacing sites in all patients with clinical VT. In the eight patients without clinical VT, we were unable to induce sustained reentry in our simulations using rapid ventricular pacing. Application of our non-invasive approach in children with myocarditis has the potential to correctly identify those at risk for developing VT.

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Zusatzmaterial
Online Resource 1 Video showing three-dimensional pattern of simulated reentrant ventricular tachycardia in patient 1 following endocardial pacing (AVI 42040 KB)
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Online Resource 2 Video showing three-dimensional pattern of simulated reentrant ventricular tachycardia in patient 4 following endocardial pacing (AVI 47839 KB)
246_2019_2082_MOESM2_ESM.avi
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