**3. Results**

#### **3.1. Survival rate**

Intraoperative mortality for the patients underwent LVR comprised 5% (9/188). For the pa‐ tients of the study group (LVR with EE) mortality was 4% (3/84), for the patients of the con‐ trol group (LVR without EE) – 6% (6/104). One year survival was 92% (77/84) for the patients subjected to LVR with EE and 87% (90/104) for those from the control group. The causes of mortality are shown in Table 2.

**5. EPhS with LV electroanatomical mapping**

possibility of re-entry and VT induction (Figure 2).

cardiac death.

**6. Contrast-enhanced MRI**

affected lateral LV wall.

Analyzing the results we decided to allocate the patients who underwent EPhS with electro‐ anatomical LVR before and after the surgery into separate groups. Fourty patients from the study group were included into group 1 and 38 from the control group into group 2. In the early postoperative period in the patients of group 1 the values of EPhS improved: "electri‐ cal scar" zones were found on endoventricular patch only, areas of lowered potential disap‐ peared completely, transient zones (from 0,5 to 1,5 mV) took a limited area without

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In 2nd group patients spontaneous VT spells were registered by Holter monitoring in 6 cases; in 8 cases VT was induced during EPhS which made in total 37% of the patients. In 12 pa‐ tients cardioverters-defibrillators were implanted for the secondary prevention of a sudden

Analyzing the obtained MRI values characterizing local morphological condition of the my‐ ocardium with values of local electrical myocardial potential we found a significant differ‐ ence as for the thickness of viable myocardium (i.e. myocardium which does not accumulate contrast paramagnetic agent) in comparable segments. Thus in the zones with normal po‐ tential (0 decrease) the thickness of viable myocardium was more than 7 mm - on average 9,8mm; in transient zone (lowered potential 1) it was 6,2mm; in low potential zone (lowered potential 2) – 5,3mm and in "electrical scar" zone (lowered potential 3) – 2,8 mm. In the lat‐ ter case viable myocardium was thinner than 3,5mm in all the segments. Figure 4 shows an example of a typical MR image in a patient with a previous acute myocardial infarction and

In the segments 10,11, 12 the uptake of contrast with the index of transmurality ranging from 0,20 to 0,55 is obviously seen. Later on during the electrophysiological study the activi‐

Besides, the value of transmural index (TI) of paramagnetic contrast agent accumulation in myocardium differed significantly between unaffected segments with 0 degree potential lowering and segments with the 1st and 2nd degrees of potential lowering –the most arrhyth‐ mogenic degrees (Figure 4). In electrically normal myocardial segments, in particular, TI val‐ ue was 0,072 ± 0,020. In the group of segments in transient zone TI was 0,46 ± 0,046, and in the low potential zone - 0,32 ± 0,052. Finally, the most affected myocardium with TI of 0,32 ±

By the data of ROC analysis and discriminative analysis the most appropriate breaking val‐ ue allowing to differentiate segments with abnormal electrical activity became TI value of 0,27. In other words, when TI ≥ 0,27 one should consider probable arrhythmogenic activity

0,052 was found in the area of an "electrical scar" with no electrical potential.

in such a segment and pay closer attention to such areas during EPhS.

ty of proarrhythmogenic type 2 was revealed. (original data)


**Table 2.** Surgical outcomes of the patients in 1 year after the intervention.
