Arrhythmias & electrophysiology
Noninvasive assessment of the ventricular arrhythmogenic substrate using electrocardiographic imaging during sinus rhythm: The NIAVAS study
Authors' conclusion
This study introduces a novel regional ECGI methodology demonstrating that rAD identifies abnormalities linked to arrhythmogenic substrate and could help identify patients at risk of VT. These findings highlight ECGI's potential as a complementary tool to LGE-CMR.
Study context
- Population
- Patients with ischemic cardiomyopathy (ICM) and controlspatients included · ICM evidenced by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) referred for ventricular tachycardia (VT) ablation 29 · ICM with implantable cardioverter-defibrillator for primary prevention without documented VT 17 · controls 26 · subgroup with electroanatomic mapping 16
- Participants
- Seventy-two patients
- Comparison
- Electrocardiographic imaging (ECGI)-derived regional activation dispersion (rAD) and pseudo-regional conduction velocity (pseudo-rCV) compared between scarred and healthy regions based on LGE, and between patients with ICM with and without previous VT
- ICM evidenced by LGE-CMR referred for VT ablationn = 29
- ICM with implantable cardioverter-defibrillator for primary prevention without documented VTn = 17
- Controlsn = 26
- Outcome
- rAD, scarred vs healthy regions
Main finding
As reported in the abstract
P < 0.001
Further findings
| Outcome | Values | P value |
|---|---|---|
| pseudo-rCV, scarred vs healthy regionsReduced pseudo-rCV in scarred regions | Scarred regions 149.9 ± 3.0 cm/s · healthy regions 165.7 ± 2.4 cm/s | P < 0.001 |
| rAD in regions containing deceleration zones (subgroup with sinus rhythm electroanatomic mapping)Regions containing deceleration zones vs other regions · increased rAD | regions containing deceleration zones 64.9 ± 5.4 ms · other regions 43.1 ± 3.1 ms | P < 0.001 |
- rAD in regions containing deceleration zones (subgroup with sinus rhythm electroanatomic mapping) — Deceleration zones identified by ECGI (subgroup with sinus rhythm electroanatomic mapping):
- 70.4%
Mean of the 3 regions with the highest activation dispersion: patients with ICM with vs without previous VT
- Cutoff
- rAD ≥60.0 ms
- Sensitivity
- 75.9%
- AUC
- 0.75
- P
- P = 0.005
Mean of the 3 regions with the highest activation dispersion: patients with ICM vs controls
- Cutoff
- rAD ≥39.5 ms
- AUC
- 0.93
Original publication
Noninvasive assessment of the ventricular arrhythmogenic substrate using electrocardiographic imaging during sinus rhythm: The NIAVAS study. Heart Rhythm. Published 17 July 2025. doi:10.
Summarised from the published abstract; every number is checked against it