Background and aims Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) detects myocardial scarring, a risk factor for ventricular arrhythmias (VA) in hypertrophic cardiomyopathy (HCM). LGE-CMR distinguishes core, borderzone (BZ) fibrosis, and BZ channels, crucial components of reentry circuits. We studied how scar architecture affects inducibility and electrophysiological traits of VA in HCM. Methods We correlated scar composition with programmed ventricular stimulation (PVS)-inducible VA features using LGE intensity maps. Results Thirty consecutive patients were enrolled. Thirteen (43%) were non-inducible, 6 (20%) had inducible non-sustained, and 11 (37%) had inducible sustained mono-(MMVT) or polymorphic VT/VF (PVT/VF). Of 17 induced VA, 13 (76%) were MMVT that either ended spontaneously, persisted as sustained monomorphic, or degenerated into PVT/VF. Twenty-seven patients (90%) had LGE. Of these, 17 (57%) had non-sustained or sustained inducible VA. Scar mass significantly increased (p = 0.002) from non-inducible to inducible non-sustained and sustained VA patients in both the BZ and core components. BZ channels were found in 23%, 67%, and 91% of non-inducible, inducible non-sustained, and inducible sustained VA patients (p = 0.003). All 13 patients induced with MMVT or monomorphic-initiated PVT/VF had LGE. The origin of 10/13 of these VTs matched scar location, with 8/10 of these LGE regions showing BZ channels. During follow-up (20 months, IQR:7-37) one patient with BZ channels and inducible PVT had an ICD shock for VF. Conclusions Scar architecture determines inducibility and electrophysiological traits of VA in HCM. Larger studies should explore the role of complex LGE patterns in refining risk assessment in HCM patients.

中文翻译：

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疤痕结构影响肥厚型心肌病诱发室性心律失常的电生理特征

背景和目的 晚期钆增强心脏磁共振 (LGE-CMR) 可检测心肌疤痕，这是肥厚型心肌病 (HCM) 中室性心律失常 (VA) 的危险因素。LGE-CMR 区分核心纤维化、边界区纤维化和 BZ 通道，它们是折返回路的关键组成部分。我们研究了疤痕结构如何影响 HCM 中 VA 的诱导性和电生理特征。方法 我们使用 LGE 强度图将疤痕成分与程序性心室刺激 (PVS) 诱导的 VA 特征相关联。结果 连续招募了 30 名患者。13 例 (43%) 为非诱导型，6 例 (20%) 为诱导型非持续型，11 例 (37%) 为诱导型持续单 (MMVT) 或多态 VT/VF (PVT/VF)。在 17 例诱导的 VA 中，13 例 (76%) 是 MMVT，要么自发结束，要么持续单态，要么退化为 PVT/VF。27 名患者 (90%) 患有 LGE。其中，17 例 (57%) 具有非持续或持续诱导型 VA。在 BZ 和核心组件中，从不可诱导到可诱导的非持续和持续 VA 患者，疤痕质量显着增加 (p = 0.002)。在 23%、67% 和 91% 的非诱导型、诱导型非持续型和诱导型持续 VA 患者中发现了 BZ 通道 (p = 0.003)。所有 13 名接受 MMVT 或单形起始 PVT/VF 诱导的患者均患有 LGE。10/13 的这些 VT 的起源与疤痕位置相匹配，其中 8/10 的这些 LGE 区域显示 BZ 通道。在随访期间（20 个月，IQR：7-37），一名具有 BZ 通道和可诱导 PVT 的患者因 VF 接受了 ICD 电击。结论 疤痕结构决定了 HCM 中 VA 的诱导能力和电生理特征。更大规模的研究应该探讨复杂的 LGE 模式在完善 HCM 患者风险评估中的作用。