AIMS: Substrate-based ablation of ventricular tachycardia (VT) relies on electroanatomical voltage mapping (EAVM). Integration of scar information from contrast-enhanced magnetic resonance imaging (CE-MRI) with EAVM may provide supplementary information. This study assessed the relation between electrogram voltages and CE-MRI scar characteristics using real-time integration and reversed registration. METHODS AND RESULTS: Fifteen patients without implantable cardiac defibrillator (14 males, 64 ± 9 years) referred for VT ablation after myocardial infarction underwent CE-MRI. Contours of the CE-MRI were used to create three-dimensional surface meshes of the left ventricle (LV), aortic root, and left main stem (LM). Real-time integration of CE-MRI-derived scar meshes with EAVM of the LV and aortic root was performed using the LM and the CARTO surface registration algorithm. Merging of CE-MRI meshes with EAVM was successful with a registration error of 3.8 ± 0.6 mm. After the procedure, voltage amplitudes of each mapping point were superimposed on the corresponding CE-MRI location using the reversed registration matrix. Infarcts on CE-MRI were categorized by transmurality and signal intensity. Local bipolar and unipolar voltages decreased with increasing scar transmurality and were influenced by scar heterogeneity. Ventricular tachycardia reentry circuit isthmus sites were correlated to CE-MRI scar location. In three patients, VT isthmus sites were located in scar areas not identified by EAVM. CONCLUSION: Integration of MRI-derived scar maps with EAVM during VT ablation is feasible and accurate. Contrast-enhanced magnetic resonance imaging identifies non-transmural scars and infarct grey zones not detected by EAVM according to the currently used voltage criteria and may provide important supplementary substrate information in selected patients.
AIMS: Substrate-based ablation of ventricular tachycardia (VT) relies on electroanatomical voltage mapping (EAVM). Integration of scar information from contrast-enhanced magnetic resonance imaging (CE-MRI) with EAVM may provide supplementary information. This study assessed the relation between electrogram voltages and CE-MRI scar characteristics using real-time integration and reversed registration. METHODS AND RESULTS: Fifteen patients without implantable cardiac defibrillator (14 males, 64 ± 9 years) referred for VT ablation after myocardial infarction underwent CE-MRI. Contours of the CE-MRI were used to create three-dimensional surface meshes of the left ventricle (LV), aortic root, and left main stem (LM). Real-time integration of CE-MRI-derived scar meshes with EAVM of the LV and aortic root was performed using the LM and the CARTO surface registration algorithm. Merging of CE-MRI meshes with EAVM was successful with a registration error of 3.8 ± 0.6 mm. After the procedure, voltage amplitudes of each mapping point were superimposed on the corresponding CE-MRI location using the reversed registration matrix. Infarcts on CE-MRI were categorized by transmurality and signal intensity. Local bipolar and unipolar voltages decreased with increasing scar transmurality and were influenced by scar heterogeneity. Ventricular tachycardia reentry circuit isthmus sites were correlated to CE-MRI scar location. In three patients, VT isthmus sites were located in scar areas not identified by EAVM. CONCLUSION: Integration of MRI-derived scar maps with EAVM during VT ablation is feasible and accurate. Contrast-enhanced magnetic resonance imaging identifies non-transmural scars and infarct grey zones not detected by EAVM according to the currently used voltage criteria and may provide important supplementary substrate information in selected patients.
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Saenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: J Interv Card Electrophysiol Date: 2020-10 Impact factor: 1.900
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Authors: Qian Tao; Sebastiaan R D Piers; Hildo J Lamb; Katja Zeppenfeld; Rob J van der Geest Journal: Int J Cardiovasc Imaging Date: 2014-10-24 Impact factor: 2.357
Authors: Charlotte Eitel; Gerhard Hindricks; Matthias Grothoff; Matthias Gutberlet; Philipp Sommer Journal: Curr Cardiol Rep Date: 2014-08 Impact factor: 2.931
Authors: Takeshi Sasaki; Christopher F Miller; Rozann Hansford; Juemin Yang; Brian S Caffo; Menekhem M Zviman; Charles A Henrikson; Joseph E Marine; David Spragg; Alan Cheng; Harikrishna Tandri; Sunil Sinha; Aravindan Kolandaivelu; Stefan L Zimmerman; David A Bluemke; Gordon F Tomaselli; Ronald D Berger; Hugh Calkins; Henry R Halperin; Saman Nazarian Journal: Circ Arrhythm Electrophysiol Date: 2012-11-13