Abstract 9169: A Non-Invasive Virtual Heart Approach Predicts Reentrant Ventricular Arrythmia (VA) Circuits in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A Proof-of-Concept Study

Abstract

Introduction: ARVC is a leading inherited cause of VA in young adults. Progressive and extensive structural and electrical remodeling in the right ventricle (RV) serves as a complex substrate for reentrant VA circuits in ARVC. Non-invasive prediction of ARVC reentrant VA circuits could provide a thorough pre-ablation evaluation of the arrhythmogenic substrate and identify specific region(s) to target during the ablation procedure. Here we developed a non-invasive personalized virtual heart approach that accurately predicts reentrant VA circuits in ARVC patients. Methods: As a proof-of-concept retrospective study, we constructed 3D computational models of ARVC patients’ hearts from LGE-CMR scans with observed RV hyperenhancements representing arrhythmogenic substrates (Fig A). 3 patients were included in this study: patient 1 (P1) had clinical VA and inducibility in electrophysiologic study (EPS); patient 2 (P2) had negative EPS despite previous evidence of VA; patient 3 had no VA. We generated a computational model for each heart incorporating personalized diffuse and dense (scar) fibrosis distribution. ARVC-specific ionic and conduction properties were represented in different regions. The VA inducibility of each model was assessed by rapid pacing from 9 RV sites. Results: For all cases, model outcomes correlated with clinical observations. In P1 model, VA was induced from the inferior basal region, as observed in EPS. Reentrant wavefronts occurred endocardially near the patient’s scar region, matching the EPS (Fig C1). Clinical ablation at this location terminated VA. In P2, VA was induced by pacing from the inferior lateral wall, a pacing location not part of the EPS protocol; reentry occurred on the basal lateral wall (Fig C2), a common location for VA circuits in ARVC. No VA was induced in P3. Conclusions: The novel ARVC virtual heart approach accurately predicts reentrant VA circuits and can potentially become a tool in assisting ablation in ARVC patients.