Assessment of Ventricular Tachycardia Scar Substrate by Intracardiac Echocardiography

Abstract

ICE provides important information about the VT anatomical substrate and may have potential to identify areas of scarred myocardium.

Advancement in cardiac imaging for treatment of ventricular arrhythmias in structural heart disease

“…47 Intracardiac echocardiography has been used to delineate scar based on wall-thinning, wall motion abnormalities, 48 and occasionally the heterogeneity in SI. 49 Although widely used, different cardiac image modalities have not been histologically validated for most aetiologies, as summarized in Table 1 and visualized in Figure 1. Briefly, in ICM LGE-CMR (both binary and ternary methods), 4,39,40,50,51 contrast-enhanced Figure 1 Overview of the available evidence on invasive and non-invasive methods of scar delineation in different aetiologies related to monomorphic sustained tachycardia.…”

“…Low BV areas (<0.5 mV) showed significantly higher ICE derived SI (mean pixel SI unit) compared to areas with border zone voltages (0.5-1.5 mV) and normal myocardium areas, whereas EAVM border zone areas showed higher SI heterogeneity on ICE (SD of SI). 49 In ARVC, both wall motion abnormalities and LGE on CMR have been compared with EAVM data. A good correlation between dyskinetic regions on CMR and low BV areas (<1.5 mV) has been reported.…”

Assessment of Ventricular Tachycardia Scar Substrate by Intracardiac Echocardiography

“…The echogenicity was assessed qualitatively, however. Hussein et al compared low-voltage zones on electroanatomic maps and ICE-derived signal intensities and showed that it was possible to identify the anatomical substrate of VT electroanatomically 4) . However, they did not analyze LGE-positive and -negative segments in relation to ICE-derived signal intensities.…”

Technology update: intracardiac echocardiography &ndash; a review of the literature

“…Thus, the identification of these akinetic areas as arrhythmogenic substrate is a useful endpoint for a successful ablation. The identification of the akinetic and diskinetic areas or aneurismatic dilatation by ICE could give additional information 26 , 27 compared to traditional electroanatomic mapping system, defining not only the relevant arrhythmogenic myocardial areas but also the wall thickness before ablation. 27 , 28 This imaging tool could be helpful also in the context of epicardial ablation of VT. 28 …”