Arrhythmias & electrophysiology
Endo–epicardial electrical disarray in arrhythmogenic cardiomyopathy with ventricular arrhythmias
Authors' conclusion
In patients with ACM, VFH identified a significantly increased heterogeneity in electrical propagation at sites of scar and DZs, but also in normal-voltage areas adjacent to low-voltage areas and on the endocardium. This could indicate microstructural alterations and/or transmural disease progression that are missed in traditional assessments but unmasked by VFH, and could complement existing substrate mapping approaches in ACM.
Study context
- Population
- Patients with arrhythmogenic cardiomyopathy (ACM) with ventricular arrhythmiaspatients included
- Participants
- 23 patients
- Exposure
- Vector field heterogeneity (VFH) values were compared between endo- and epicardial maps and across omnipolar voltage (OV)-defined regions
- Outcome
- VFH across voltage categories
Methodological detailshigh-density endo-epicardial substrate maps, 16-pole grid catheter
- High-density endo-epicardial substrate maps
- 16-pole grid catheter
Main finding
As reported in the abstract
Scar (OV <0.3 mV), epi
0.57
0.28
Scar (OV <0.3 mV), endo
0.56
0.30
- VFH differed significantly across voltage categories
- P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | Normal | Border zone | Scar | DZs | |
|---|---|---|---|---|---|
| VFH at DZs | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | 0.59 [0.25] | normal, border zone, scar: not reported in the abstract |
- VFH in border zone regions: border zone, epicardial 0.41 [0.42]
- VFH in border zone regions: border zone, endocardial 0.39 [0.45]
- VFH in normal OV areas: normal, epi 0.17 [0.27]
- VFH in normal OV areas: normal, endo 0.29 [0.34]
- VFH at deceleration zones (DZs): DZs during sensed extras 0.62 [0.28]
- VFH at DZs: P = .88
- Epicardial normal-voltage regions directly adjacent to low-voltage substrate vs overall normal-voltage areas: adjacent normal-voltage 0.26 [0.32]
- Epicardial normal-voltage regions directly adjacent to low-voltage substrate vs overall normal-voltage areas: overall normal-voltage 0.17 [0.27]
- Epicardial normal-voltage regions directly adjacent to low-voltage substrate vs overall normal-voltage areas: P < .001
Original publication
Endo–epicardial electrical disarray in arrhythmogenic cardiomyopathy with ventricular arrhythmias. Heart Rhythm. Published 9 September 2025. doi:10.
Summarised from the published abstract; every number is checked against it