Clinical Application of PET/CT Fusion Imaging for Three‐Dimensional Myocardial Scar and Left Ventricular Anatomy during Ventricular Tachycardia Ablation

Tian, Jing; Smith, Mark F.; Chinnadurai, Ponraj; Dilsizian, Vasken; Turgeman, Aharon; Abbo, Aharon; Gajera, Kalpitkumar; Xu, Chenyang; Plotnick, Daniel S.; Peters, Robert W.; Saba, Magdi; Shorofsky, Stephen R.; Dickfeld, Timm

doi:10.1111/j.1540-8167.2008.01377.x

Cited by 53 publications

(36 citation statements)

References 35 publications

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“…The reconstructed images were registered with voltage maps using precommercial CartoMERGE software. 10 Primary registration was performed with Landmark points and visual alignments as previously published. 10 Scar surface area and LV scar burden (scar surface area/total LV surface) were compared between the voltage map and 3D CE-CT reconstructions with the internal CartoMERGE measurement tools.…”

Section: Three-dimensional Ce-ct Image Reconstructionmentioning

confidence: 99%

Three-Dimensional Contrast-Enhanced Multidetector CT for Anatomic, Dynamic, and Perfusion Characterization of Abnormal Myocardium To Guide Ventricular Tachycardia Ablations

Tian

Jeudy

Smith

et al. 2010

Circ: Arrhythmia and Electrophysiology

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106

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Section: Three-dimensional Ce-ct Image Reconstructionmentioning

confidence: 99%

Three-Dimensional Contrast-Enhanced Multidetector CT for Anatomic, Dynamic, and Perfusion Characterization of Abnormal Myocardium To Guide Ventricular Tachycardia Ablations

Tian

Jeudy

Smith

et al. 2010

Circ: Arrhythmia and Electrophysiology

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106

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“…Recently, we showed that PET-derived myocardial scars can be successfully registered to display scars for VT ablations (6,7). Although PET has spatial resolution superior to SPECT (15,16), the availability of PET is limited because of higher costs.…”

Section: Rationale For Using Spect 3d Scar Modelsmentioning

confidence: 99%

“…3D SPECT scar surface models and voltage maps were compared using a 17-segment cardiac model (6). Segments were visually classified by an experienced cardiologist.…”

Section: Comparison Of 3d Spect Scar and Surface Models With Voltage mentioning

confidence: 99%

“…In previous work, we investigated the integration of scar models from 18 F-FDG PET into a clinical electrophysiology mapping system and found good correlations between the PET scar models and the electrophysiology voltage maps (6,7). Though PET offers advantages over SPECT in terms of superior resolution and reduced image noise, SPECT is a well-established and validated technique for identifying myocardial scar and is more widely available (8,9).…”

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Integration of 3-Dimensional Scar Models from SPECT to Guide Ventricular Tachycardia Ablation

Tian¹,

Smith²,

Ahmad³

et al. 2012

J Nucl Med

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The integration of myocardial scar models in 3-dimensional (3D) mapping systems may provide a novel way of helping to guide ventricular tachycardia (VT) ablations. This study assessed the value of 201 Tl SPECT perfusion imaging to define ventricular myocardial scar areas and to characterize electrophysiology voltage-derived myocardial substrate categories of scar, border zone (BZ), and normal myocardium regions. Scar and BZ regions have been implicated in the genesis of ventricular arrhythmias. Methods: Ten patients scheduled for VT ablation underwent 201 Tl SPECT before the ablation procedure. 3D left ventricular (LV) scar models were created from the SPECT images. These scar models were registered with the LV voltage maps and analyzed with a 17-segment cardiac model. Scar location and scar burden were compared between the SPECT scar models and voltage maps. In addition, 201 Tl SPECT uptake was quantified using a 68-segment cardiac model and compared among voltage-defined scar, BZ, and normal segments. Results: 3D models of LV myocardium and scar were successfully created from 201 Tl SPECT images and integrated in a clinical mapping system. The surface registration error with the electrophysiology voltage map was 4.4 6 1.0 mm. The 3D scar location from SPECT matched in 72% of the segments with the voltage map findings. All successful ablation sites were located within the SPECTdefined scar or within 1 cm of its border, with 73% of the successful ablation sites within 1 cm of the scar border. Voltage measurements in SPECT-defined scar and normal areas were 1.2 6 1.7 and 3.4 6 2.8 mV, respectively (P , 0.001). The fractional SPECT scar burden area (18.8% 6 5.2%) agreed better with the abnormal (scar plus BZ) voltage area (20.8% 6 15.7%) than with the scar voltage area (5.8% 6 5.8%). Mean normalized 201 Tl uptake was 55% 6 21% in the voltage-defined scar, 63% 6 20% in BZ, and 79% 6 17% in normal myocardial segments (P , 0.05 for scar or BZ vs. normal). Conclusion: 3D SPECT surface models of LV scar were accurately integrated into a clinical mapping system and predicted endocardial voltage-defined scar. These preliminary data support the possible use of widely available 201 Tl SPECT to facilitate substrateguided VT ablations. Pat ients with internal cardiac defibrillators (ICD) may present with frequent shocks for ventricular tachycardia (VT) that are an appropriate response to the arrhythmia. Radiofrequency ablation of VT is required in many of these patients because of the side effects and decreasing longterm efficacy of antiarrhythmic medications. A substrateguided approach is required in 60%-90% of patients because of the multiple morphologies and hemodynamic intolerance of VT (1,2). In these approaches, linear ablation lines are placed across and along the myocardial scar and its border zone (BZ) to interrupt conducting channels of surviving myocardium (1,3,4). The current gold standard of scar delineation consists of voltage mapping, which is limited by catheter contact, mapping density, and inability to ...

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“…One possible explanation is that current imaging techniques do not take into consideration the triggering mechanisms and substrate modulators, such as sympathetic cardiac innervation (4)(5)(6)(7)(8)(9). The relationships between cardiac autonomic nervous system dysfunction, cardiomyopathy, and cardiac arrhythmias have been long established (10)(11)(12).…”

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confidence: 99%

Global and Regional Myocardial Innervation Before and After Ablation of Drug-Refractory Ventricular Tachycardia Assessed with ¹²³I-MIBG

et al. 2015

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Cardiac innervation is a critical component of ventricular arrhythmogenesis that can be noninvasively assessed with 123 I-MIBG. However, the effect of ventricular tachycardia (VT) ablation on global and regional left ventricular sympathetic innervation and clinical outcomes has not been previously assessed. Methods: In this prospective, single-center feasibility study, 13 patients with cardiomyopathy (n 5 9 ischemic, n 5 4 nonischemic) who were scheduled to undergo ablation of drug-refractory VT underwent 15-min and 4-h 123 I-MIBG scans before and 6 mo after the ablation procedure. Planar and arrhythmia-specific 757-segment analysis of short-axis SPECT images was performed in all datasets. Results: Global innervation assessed with heart-to-mediastinal ratio and washout rates was preserved in all patients at baseline (1.8 [continuous variables are expressed as median and quartile: Q1-Q3, 1.7-2.4] and 54% [Q1-Q3, 47%-67%]) and did not change significantly at the 6-mo follow-up (1.9 [Q1-Q3, 1.6-2.2], P 5 0.9; and 56% [Q1-Q3, 41%-62%], P 5 0.6). However, segmental analysis demonstrated that ischemic patients had larger areas of abnormal innervation at baseline (52.1% vs. 19.6%, P 5 0.011) and at the 6-mo follow-up (56.7% vs. 27.5%, P 5 0.011) than the nonischemic patients. Innervation defects affected 40% of the inferior segments in all ischemic cardiomyopathy patients, whereas they affected only 10% of inferior segments in 75% of nonischemic patients. When segmental data were further analyzed in denervated (DZ), transition (TZ), and normal (NZ) zones, there were changes in these designated innervation categories from baseline to the 6-mo follow-up for ischemic (19% DZ, 59% TZ, 22% NZ) and nonischemic (6% DZ, 45% TZ, 15% NZ) patients. In ischemic patients, relative changes were significantly greater in the TZ segments than in the DZ, which demonstrated the second highest proportional changes (P 5 0.028). Receiver operating characteristic curves defined best cutoffs of DZ, TZ, and NZ as less than 30.5%, 30.6%-47.1%, and more than 47.1%, respectively. Conclusion: Patients with ischemic cardiomyopathy have larger areas of abnormal innervation than those with nonischemic cardiomyopathy. Although VT ablation did not change global innervation, a novel arrhythmia-specific segmental analysis demonstrated significant dynamic changes in innervation categories and allowed quantitative definitions of DZ, TZ, and NZ.These findings provide novel insights into the mechanics of sympathetic innervation in patients undergoing VT ablation and may have diagnostic and therapeutic implications.

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Clinical Application of PET/CT Fusion Imaging for Three‐Dimensional Myocardial Scar and Left Ventricular Anatomy during Ventricular Tachycardia Ablation

Cited by 53 publications

References 35 publications

Three-Dimensional Contrast-Enhanced Multidetector CT for Anatomic, Dynamic, and Perfusion Characterization of Abnormal Myocardium To Guide Ventricular Tachycardia Ablations

Three-Dimensional Contrast-Enhanced Multidetector CT for Anatomic, Dynamic, and Perfusion Characterization of Abnormal Myocardium To Guide Ventricular Tachycardia Ablations

Integration of 3-Dimensional Scar Models from SPECT to Guide Ventricular Tachycardia Ablation

Global and Regional Myocardial Innervation Before and After Ablation of Drug-Refractory Ventricular Tachycardia Assessed with ¹²³I-MIBG

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Clinical Application of PET/CT Fusion Imaging for Three‐Dimensional Myocardial Scar and Left Ventricular Anatomy during Ventricular Tachycardia Ablation

Cited by 53 publications

References 35 publications

Three-Dimensional Contrast-Enhanced Multidetector CT for Anatomic, Dynamic, and Perfusion Characterization of Abnormal Myocardium To Guide Ventricular Tachycardia Ablations

Three-Dimensional Contrast-Enhanced Multidetector CT for Anatomic, Dynamic, and Perfusion Characterization of Abnormal Myocardium To Guide Ventricular Tachycardia Ablations

Integration of 3-Dimensional Scar Models from SPECT to Guide Ventricular Tachycardia Ablation

Global and Regional Myocardial Innervation Before and After Ablation of Drug-Refractory Ventricular Tachycardia Assessed with 123I-MIBG

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Global and Regional Myocardial Innervation Before and After Ablation of Drug-Refractory Ventricular Tachycardia Assessed with ¹²³I-MIBG