MRI-Guided Ventricular Tachycardia Ablation

Dickfeld, Timm; Tian, Jing; Ahmad, Ghada; Jiménez, Alejandro; Turgeman, Aharon; Kuk, Richard; Peters, Matthew; Saliaris, Anastasios; Saba, Magdi; Shorofsky, Stephen R.; Jeudy, Jean

doi:10.1161/circep.110.958744

Cited by 185 publications

(59 citation statements)

References 30 publications

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“…Our results are consistent with findings of contrast-enhanced CT to define the LV scar substrate. The area of first-pass hypoperfusion CT or late gadolinium-enhancement MRI approximated the area of less than 1.5 mV better than the area of less than 0.5 mV in patients with ischemic cardiomyopathy (13,17). All successful ablation sites were located within the SPECT-defined scar or within 1 cm of its border, with 73% of the successful ablation sites within 1 cm of the scar border.…”

Section: Correlations Of Myocardial Scar Area or Burden With Electropmentioning

confidence: 91%

“…Correlating the possible exit location derived from the 12-lead morphology of the clinical or induced VT with the border of the SPECT scar model that has been integrated in the clinical mapping system may allow identification of an acceptable pace-map site without the performance of a full LV voltage map. Indeed, a similar approach using MRI scar models allowed the early identification of at least 11 of 12 pace-map sites in 64% of patients (17).…”

Section: Correlations Of Myocardial Scar Area or Burden With Electropmentioning

confidence: 99%

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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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Section: Correlations Of Myocardial Scar Area or Burden With Electropmentioning

confidence: 91%

Section: Correlations Of Myocardial Scar Area or Burden With Electropmentioning

confidence: 99%

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

Tian¹,

Smith²,

Ahmad³

et al. 2012

J Nucl Med

Self Cite

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“…When integrated in the electroanatomic systems, it provides topography and transmural extent of the fibrotic tissue and, hence, of the low voltage areas, simplifying the identification of the arrhythmogenic substrate during voltage mapping in sinus rhythm [65,66] . This is expected to significantly shorten mapping time, increase the success rate and reduce the complication rate.…”

Section: Imaging Integrationmentioning

confidence: 99%

“…In general, ICD and claustrophobia are considered contraindications for magnetic resonance imaging. However, using appropriate precautions this imaging modality is possible even in ICD patients, who represent a vast proportion of candidates for VT ablation [38,66] .…”

Section: Imaging Integrationmentioning

confidence: 99%

Role of catheter ablation of ventricular tachycardia associated with structural heart disease

Ponti

2011

WJC

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In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the short-and long-term prognosis. Several therapeutic options can be considered for the management of this arrhythmia. Among others, catheter ablation, a closed-chest therapy, can prevent arrhythmia recurrences by abolishing the arrhythmogenic substrate. Over the last two decades, different techniques have been developed for an effective approach to both tolerated and untolerated VTs. The clinical outcome of patients undergoing ablation has been evaluated in multiple studies. This editorial gives an overview of the role, methodology, clinical outcome and innovative approaches in catheter ablation of VT. De Ponti R. Role of catheter ablation of ventricular tachycardia associated with structural heart disease.

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“…Making the scar information from the MRI available within the ablation environment could help reduce procedure time. Dickfeld et al [11] have already showed the feasibility of 3D MRI scar reconstructions to facilitate VT ablations. The next step is the search for the best visual integration of the MRI scar information and the voltage measurements, which is the research topic described in this paper.…”

Section: Introductionmentioning

confidence: 99%

Cardiac MRI visualization for ventricular tachycardia ablation

et al. 2012

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Objective The integrated visualization of cardiac MRI during a ventricular tachycardia (VT) mapping and ablation procedure would provide improved catheter guidance and tissue assessment. We developed a system for and explored the added value of simultaneous visualization of intracardiac voltage measurements and MRI-derived myocardial scar information during VT ablation procedures. Method We propose the use of a synchronized 3D and 2D view. In 3D, the catheter will be guided optimally by assessing 3D scar characteristics and its relation to the ventricular anatomy. In 2D, a detailed assessment of the tissue can be made. We developed several 3D visualization techniques, including volume rendering of the scar and myocardial surfaces colored according to the voltage measurements. We also visualized context structures in the heart. For the 2D view, we proposed showing three adjacent slices simultaneously. To link the 3D with the 2D view, we added a linking plane and linking contours; the slice level shown in the 2D view is indicated in the 3D view. Results We evaluated our method via a case study during which we simulated the visual environment of an ablation procedure. The MRI-based volume rendering of scar tissue and the linking between the 3D and 2D views were both positively received. However, the visualization of the voltage measurements was found to be hard to interpret, partly due to the perceptually suitable but non-standard colormap. Conclusions Based on this study, we can conclude that our approach of displaying MRI data and integrating it with voltage measurements has potential to improve VT ablation procedures.

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MRI-Guided Ventricular Tachycardia Ablation

Abstract: Background-Substrate-guided ablation of ventricular tachycardia (VT)

Cited by 185 publications

References 30 publications

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

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

Role of catheter ablation of ventricular tachycardia associated with structural heart disease

Cardiac MRI visualization for ventricular tachycardia ablation

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