Integration of 3D Electroanatomic Maps and Magnetic Resonance Scar Characterization Into the Navigation System to Guide Ventricular Tachycardia Ablation

Abstract

Background-Scar heterogeneity identified with contrast-enhanced cardiac magnetic resonance (CE-CMR) has been related to its arrhythmogenic potential by using different algorithms. The purpose of the study was to identify the algorithm that best fits with the electroanatomic voltage maps (EAM) to guide ventricular tachycardia (VT) ablation. Methods and Results-Three-dimensional scar reconstructions from preprocedural CE-CMR study at 3T were obtained and compared with EAMs of 10 ischemic patients submitted for a VT ablation. Three-dimensional scar reconstructions were created for the core (3D-CORE) and border zone (3D-BZ), applying cutoff values of 50%, 60%, and 70% of the maximum pixel signal intensity to discriminate between core and BZ. The left ventricular cavity from CE-CMR (3D-LV) was merged with the EAM, and the 3D-CORE and 3D-BZ were compared with the corresponding EAM areas defined with standard cutoff voltage values. The best match was obtained when a cutoff value of 60% of the maximum pixel signal intensity was used, both for core (r 2 ϭ0.827; PϽ0.001) and BZ (r

Electrophysiology Model for a Human Heart with Ischemic Scar and Realistic Purkinje Network

“…The segmentation thresholds have been previously optimized using EAM data in [1,5]. These thresholds have been used to successfully identify borderzone conducting channels during catheter ablation.…”

A Fast Convex Optimization Approach to Segmenting 3D Scar Tissue from Delayed-Enhancement Cardiac MR Images

“…Clearly, (5) just corresponds to (1) and (2). In this work, we solve the POP model (4) by its convex relaxation:…”

“…A potential for DE-MRI to guide cardiovascular procedures, such as ablative therapies for elimination of atrial or ventricular arrhythmias and the optimal placement of pacemaker leads to treat heart failure (Cardiac Resynchronization Therapy), is now being appreciated [1,2]. However, ability to translate this information into the procedural environment is a significant challenge.…”

“…However, the efficient and accurate segmentation of scar signal from these datasets presents a significant challenge. Recently, several approaches [2,3] were proposed to segment the 3D scar tissue, which employ additional information from other images to constrain the search for scar tissue within the myocardium geometrically. Additional myocardial segmentations [4], or registrations [5] to other images is time consuming and a potential source of error.…”

Bipolar irrigated radiofrequency ablation of resistant ventricular tachycardia with a septal intramural origin: the initial experience and a description of the method

“…The three‐dimensional scar visualization based on magnetic resonance imaging and electroanatomic techniques has led to a better understanding of the mechanisms of tachycardia 2, 3. However, some patients with VT have a reentrant circuit located deep in the myocardium, with most in the interventricular septum 4, 5.…”