Detection of regional low myocardial perfusion helps predict a response to cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy: Results of the Find Index by Nuclear Imaging for Dyssynchrony (FIND) study

Background: The aim of this study was to investigate the use of imaging techniques to predict the response to cardiac resynchronization therapy (CRT) in patients with non-ischemic cardiomyopathy (NICM) by simultaneous assessment of left ventricular (LV) dyssynchrony and myocardial perfusion in a single nuclear scan of the heart. Methods: Patients indicated for CRT device implantation underwent a resting myocardial perfusion assessment with single photon emission computed tomography (MP-SPECT) examination using technetium-99 m methoxyisobutylisonitrile prior to device implantation. CardioGRAF and cardioBull software (FUJIFILM RI Pharma, Tokyo, Japan) were used to analyze the LV mechanical dyssynchrony and myocardial viability, respectively. Patient follow-ups were performed at 6 months after device implantation. CRT response was defined as a ≥10% decrease in the LV end systolic volume. Results: A total of 43 patients with NICM were analyzed. Using the cutoff points of 6.2 for the dyssynchrony index and 66% for LV myocardial perfusion, the combined indices predicted CRT response with a sensitivity of 77.8% and specificity of 91.2%. Conclusion: Combined assessment of MP-SPECT and a measure of LV mechanical dyssynchrony showed good predictive ability in patients with non-ischemic heart failure

His-Purkinje system-related incessant ventricular tachycardia arising from the left coronary cusp

We describe the case of a 23-year-old woman who had His-Purkinje system-related incessant ventricular tachycardia with a narrow QRS configuration. The ventricular tachycardia was ablated successfully in the left coronary cusp where the earliest endocardial activation had been recorded. We hypothesize that a remnant of the subaortic conducting tissue was the source of the ventricular arrhythmias