Heart failure & cardiomyopathiesResearch article
Electrocardiographic imaging of repolarization abnormalities in structural heart disease for characterization of arrhythmogenic phenotypes
- Patients who underwent 252-electrode computed tomography-ECGI and delayed-enhancement magnetic resonance imaging were reviewed
Authors' conclusion
ECGI-derived ARI alterations in SHD are associated with scar presence, transmurality, and VT history. Segmental ARI dispersion in association with myocardial scar may potentially serve as a complementary non-invasive marker of arrhythmogenic risk.
Study context
- Population
- Patients with structural heart disease (SHD) who underwent 252-electrode computed tomography-ECGI and delayed-enhancement magnetic resonance imaging, categorized by myocardial scar, left ventricular ejection fraction (LVEF) and history of reentrant ventricular tachycardia (VT)patients included · scar+/VT+ 39 · scar+/VT- 14 · impaired LVEF/VT- 9 · controls 9
- Participants
- 71 patients
- Comparison
- Electrocardiographic imaging (ECGI)-derived activation time and activation-recovery interval (ARI) metrics compared across groups and tissue types
- scar+/VT+n = 39
- scar+/VT-n = 14
- impaired LVEF/VT-n = 9
- controlsn = 9
Main finding
As reported in the abstract
ARI duration and dispersion between groups and tissue types · sinus rhythm
ARI duration and dispersion differed significantly between groups and tissue types
all P < .05
Further findings
| Outcome | Values | β (ms) | P value |
|---|---|---|---|
| Segmental ARI dispersion by tissue type | transmural scar 22.0 (IQR 26.3) ms · subepicardial scar 20.6 (IQR 22.8) ms · subendocardial scar 16.5 (IQR 16.1) ms · non-scarred myocardium 15.8 (IQR 20.3) ms | ||
| ARI dispersion within scar regions | −8.4 | P = 0.009 | |
| Activation dispersion · significantly increased at sites of scar | −5.3 | P < 0.001 |
- Activation dispersion — only a trend toward distinguishing VT status
- P = .059
- Segmental ARI dispersion by tissue type: P < .001
- ARI dispersion within scar regions: significantly higher in the scar+/VT+ than the scar+/VT- cohort
Segmental ARI dispersion by tissue type
- Segmental ARI was longest over scar regions
ARI and dispersion metrics in severe left ventricular dysfunction vs controls
- Severe left ventricular dysfunction, even in the absence of overt myocardial scar, associated with significantly prolonged ARI and elevated dispersion metrics compared with controls
Original publication
Electrocardiographic imaging of repolarization abnormalities in structural heart disease for characterization of arrhythmogenic phenotypes. Heart Rhythm. Published 18 June 2026. doi:10.1016/j.hrthm.2026.06.012
Summarised from the published abstract; every number is checked against it