Author's Accepted Manuscript

Late Gadolinium Enhancement on Cardiac Magnetic Resonance Represents the Depolarizing and Repolarizing Electrically Damaged Foci Causing Malignant Ventricular Arrhythmia in Hypertrophic Cardiomyopathy Naka Sakamoto MD, Yuichiro Kawamura Ph.D., Nobuyuki Sato MD, Asami Nimura MD, Motoki Matsuki MD, Atsushi Yamauchi MD, Takayasu Kanno MD, Yasuko Tanabe MD, Toshiharu Takeuchi MD, Shunsuke Natori MD, Yasuaki Saijo MD, Tamio Aburano MD, Naoyuki Hasebe MD

PII: DOI: Reference:

S1547-5271(15)00150-2 http://dx.doi.org/10.1016/j.hrthm.2015.02.004 HRTHM6122

To appear in:

Heart Rhythm

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Cite this article as: Naka Sakamoto MD, Yuichiro Kawamura Ph.D., Nobuyuki Sato MD, Asami Nimura MD, Motoki Matsuki MD, Atsushi Yamauchi MD, Takayasu Kanno MD, Yasuko Tanabe MD, Toshiharu Takeuchi MD, Shunsuke Natori MD, Yasuaki Saijo MD, Tamio Aburano MD, Naoyuki Hasebe MD, Late Gadolinium Enhancement on Cardiac Magnetic Resonance Represents the Depolarizing and Repolarizing Electrically Damaged Foci Causing Malignant Ventricular Arrhythmia in Hypertrophic Cardiomyopathy, Heart Rhythm, http://dx.doi.org/10.1016/j.hrthm.2015.02.004 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Late Gadolinium Enhancement on Cardiac Magnetic Resonance Represents the Depolarizing and Repolarizing Electrically Damaged Foci Causing Malignant Ventricular Arrhythmia in Hypertrophic Cardiomyopathy Sakamoto; Short title: Late gadolinium enhancement shows origin of VA Naka Sakamoto, MD,* Yuichiro Kawamura, PhD,* Nobuyuki Sato, MD,* Asami Nimura, MD,* Motoki Matsuki, MD,* Atsushi Yamauchi, MD,* Takayasu Kanno, MD,* Yasuko Tanabe, MD,* Toshiharu Takeuchi, MD,* Shunsuke Natori, MD,† Yasuaki Saijo MD,‡ Tamio Aburano MD,§ Naoyuki Hasebe, MD *

From the *Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan ‡Division of Community Medicine and Epidemiology, Department of Health Science, and §Department of Radiology, Asahikawa Medical University, Asahikawa, Japan †Department of Cardiology, Furano Hospital, Furano, Japan. Short title: Delayed enhancement on cardiac MRI and VT Address for correspondence:

Nobuyuki Sato, M.D.,

Department of Cardiology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1, Asahikawa, 078-8510, Japan TEL:

81-166-68-2442; FAX: 81-166-68-2449

e-mail: [email protected] Conflicts of interests: The authors have no conflict of interest to declare. Total Word Count: 4863

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Abstract

Background: The presence of a myocardial scar detected by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) has been described as a predictor of all-cause mortality in hypertrophic cardiomyopathy (HCM). However, the detailed spatial relationship between LGE site and electrical abnormality is unclear in high risk HCM with malignant arrhythmia. Objective: To elucidate the detailed relationship between the site on CMR imaging and the electrically damaged site, a potential origin of ventricular arrhythmias in patients with HCM. Methods: Fifty consecutive HCM patients underwent contrast-enhanced CMR. Among them, 18 patients with ventricular tachycardia (VT) underwent electrophysiologic study including endocardial mapping of the left ventricle (LV). LGE area was calculated at 12 different LV sites; Anterior, Lateral, Posterior and Septal segments of the Basal, Middle and Apical portions. At each LV site, the bipolar electrogram, effective refractory period (ERP), and monophasic action potential (MAP) were recorded. Results: LGE-positive segments demonstrated a significantly lower amplitude (4.0±2.8 versus 7.3±3.6 mV, P