Post–Myocardial Infarction Scar With Fat Deposition Shows Specific Electrophysiological Properties and Worse Outcome After Ventricular Tachycardia Ablation

BACKGROUND: Fat deposition (FD) is part of the healing process after myocardial infarction. The characteristics of FD and its impact on the outcome in patients undergoing ventricular tachycardia (VT) ablation have not been thoroughly studied. METHODS AND RESULTS: We studied consecutive patients undergoing post–myocardial infarction VT ablation with pre‐procedural cardiac computed tomography. FD was defined as intra‐myocardial attenuation ≤ −30 HU on computed tomography. Clinical, anatomical, and post‐procedural outcome was assessed in the overall population. Electrophysiological characteristics were assessed is a subgroup of patients with high‐density electro‐anatomical maps. Sixty‐nine patients were included (66±12 years). FD was detected in 44 (64%) patients. The presence of FD related to scar age (odds ratio [OR]: 1.14 per year; P=0.001) and scar extent (OR: 1.27 per segment; P=0.02). On electro‐anatomical maps, FD was characterized by lower bipolar amplitude (P<0.001) and prolonged electrogram duration (P<0.001). Although the proportion of local abnormal ventricular activation was similar (P=0.22), local abnormal ventricular activation showed lower amplitude (P<0.001) and were more delayed (P<0.001) in scars with FD. After a mean follow‐up of 26 months, patients with FD experienced a worse outcome including all‐cause mortality and VT recurrence (70% versus 28%, P log rank=0.009). On multivariate analysis, FD (hazard ratio=2.69; 95% CI, 1.12–6.46; P=0.027) and left ventricular systolic dysfunction (hazard ratio=2.57; 95% CI, 1.13–5.85; P=0.024) were independent predictors of adverse outcomes. CONCLUSIONS: FD in patients with post–myocardial infarction VT undergoing catheter ablation relates to scar age and size and may be a marker of adverse outcomes including all‐cause mortality and VT recurrence.