Integration of merged delayed-enhanced magnetic resonance imaging and multidetector computed tomography for the guidance of ventricular tachycardia ablation: a pilot study.
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State: Public
Version: Final published version
State: Public
Version: Final published version
Serval ID
serval:BIB_C8962560AF81
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Integration of merged delayed-enhanced magnetic resonance imaging and multidetector computed tomography for the guidance of ventricular tachycardia ablation: a pilot study.
Journal
Journal of Cardiovascular Electrophysiology
ISSN
1540-8167 (Electronic)
ISSN-L
1045-3873
Publication state
Published
Issued date
2013
Volume
24
Number
4
Pages
419-426
Language
english
Notes
Publication types: Evaluation Studies ; Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Abstract
BACKGROUND: Delayed enhancement (DE) MRI can assess the fibrotic substrate of scar-related VT. MDCT has the advantage of inframillimetric spatial resolution and better 3D reconstructions. We sought to evaluate the feasibility and usefulness of integrating merged MDCT/MRI data in 3D-mapping systems for structure-function assessment and multimodal guidance of VT mapping and ablation.
METHODS: Nine patients, including 3 ischemic cardiomyopathy (ICM), 3 nonischemic cardiomyopathy (NICM), 2 myocarditis, and 1 redo procedure for idiopathic VT, underwent MRI and MDCT before VT ablation. Merged MRI/MDCT data were integrated in 3D-mapping systems and registered to high-density endocardial and epicardial maps. Low-voltage areas (<1.5 mV) and local abnormal ventricular activities (LAVA) during sinus rhythm were correlated to DE at MRI, and wall-thinning (WT) at MDCT.
RESULTS: Endocardium and epicardium were mapped with 391 ± 388 and 1098 ± 734 points per map, respectively. Registration of MDCT allowed visualization of coronary arteries during epicardial mapping/ablation. In the idiopathic patient, integration of MRI data identified previously ablated regions. In ICM patients, both DE at MRI and WT at MDCT matched areas of low voltage (overlap 94 ± 6% and 79 ± 5%, respectively). In NICM patients, wall-thinning areas matched areas of low voltage (overlap 63 ± 21%). In patients with myocarditis, subepicardial DE matched areas of epicardial low voltage (overlap 92 ± 12%). A total number of 266 LAVA sites were found in 7/9 patients. All LAVA sites were associated to structural substrate at imaging (90% inside, 100% within 18 mm).
CONCLUSION: The integration of merged MDCT and DEMRI data is feasible and allows combining substrate assessment with high-spatial resolution to better define structure-function relationship in scar-related VT.
METHODS: Nine patients, including 3 ischemic cardiomyopathy (ICM), 3 nonischemic cardiomyopathy (NICM), 2 myocarditis, and 1 redo procedure for idiopathic VT, underwent MRI and MDCT before VT ablation. Merged MRI/MDCT data were integrated in 3D-mapping systems and registered to high-density endocardial and epicardial maps. Low-voltage areas (<1.5 mV) and local abnormal ventricular activities (LAVA) during sinus rhythm were correlated to DE at MRI, and wall-thinning (WT) at MDCT.
RESULTS: Endocardium and epicardium were mapped with 391 ± 388 and 1098 ± 734 points per map, respectively. Registration of MDCT allowed visualization of coronary arteries during epicardial mapping/ablation. In the idiopathic patient, integration of MRI data identified previously ablated regions. In ICM patients, both DE at MRI and WT at MDCT matched areas of low voltage (overlap 94 ± 6% and 79 ± 5%, respectively). In NICM patients, wall-thinning areas matched areas of low voltage (overlap 63 ± 21%). In patients with myocarditis, subepicardial DE matched areas of epicardial low voltage (overlap 92 ± 12%). A total number of 266 LAVA sites were found in 7/9 patients. All LAVA sites were associated to structural substrate at imaging (90% inside, 100% within 18 mm).
CONCLUSION: The integration of merged MDCT and DEMRI data is feasible and allows combining substrate assessment with high-spatial resolution to better define structure-function relationship in scar-related VT.
Keywords
Adult, Catheter Ablation/methods, Cicatrix/complications, Cicatrix/pathology, Contrast Media/diagnostic use, Coronary Angiography/methods, Electrophysiologic Techniques, Cardiac, Feasibility Studies, Female, Fibrosis, Heart Ventricles/pathology, Heart Ventricles/physiopathology, Heterocyclic Compounds/diagnostic use, Humans, Imaging, Three-Dimensional, Iopamidol/analogs & derivatives, Iopamidol/diagnostic use, Magnetic Resonance Imaging, Male, Middle Aged, Multidetector Computed Tomography, Organometallic Compounds/diagnostic use, Pilot Projects, Predictive Value of Tests, Prospective Studies, Radiographic Image Interpretation, Computer-Assisted, Tachycardia, Ventricular/etiology, Tachycardia, Ventricular/pathology, Tachycardia, Ventricular/</QualifierName> <QualifierName MajorTopicYN="Y">, Therapy, Computer-Assisted, Treatment Outcome
Pubmed
Web of science
Create date
14/07/2014 16:57
Last modification date
20/08/2019 16:43