Head-to-head comparison of contrast-enhanced magnetic resonance imaging and electroanatomical voltage mapping to assess post-infarct scar characteristics in patients with ventricular tachycardias: real-time image integration and reversed registration
Open Access
- 23 September 2010
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 32 (1), 104-114
- https://doi.org/10.1093/eurheartj/ehq345
Abstract
Substrate-based ablation of ventricular tachycardia (VT) relies on electroanatomical voltage mapping (EAVM). Integration of scar information from contrast-enhanced magnetic resonance imaging (CE-MRI) with EAVM may provide supplementary information. This study assessed the relation between electrogram voltages and CE-MRI scar characteristics using real-time integration and reversed registration. Fifteen patients without implantable cardiac defibrillator (14 males, 64 ± 9 years) referred for VT ablation after myocardial infarction underwent CE-MRI. Contours of the CE-MRI were used to create three-dimensional surface meshes of the left ventricle (LV), aortic root, and left main stem (LM). Real-time integration of CE-MRI-derived scar meshes with EAVM of the LV and aortic root was performed using the LM and the CARTO surface registration algorithm. Merging of CE-MRI meshes with EAVM was successful with a registration error of 3.8 ± 0.6 mm. After the procedure, voltage amplitudes of each mapping point were superimposed on the corresponding CE-MRI location using the reversed registration matrix. Infarcts on CE-MRI were categorized by transmurality and signal intensity. Local bipolar and unipolar voltages decreased with increasing scar transmurality and were influenced by scar heterogeneity. Ventricular tachycardia reentry circuit isthmus sites were correlated to CE-MRI scar location. In three patients, VT isthmus sites were located in scar areas not identified by EAVM. Integration of MRI-derived scar maps with EAVM during VT ablation is feasible and accurate. Contrast-enhanced magnetic resonance imaging identifies non-transmural scars and infarct grey zones not detected by EAVM according to the currently used voltage criteria and may provide important supplementary substrate information in selected patients.Keywords
This publication has 16 references indexed in Scilit:
- EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA)Heart Rhythm, 2009
- Infarct architecture and characteristics on delayed enhanced magnetic resonance imaging and electroanatomic mapping in patients with postinfarction ventricular arrhythmiaHeart Rhythm, 2009
- Infarct Tissue Heterogeneity Assessed With Contrast-Enhanced MRI Predicts Spontaneous Ventricular Arrhythmia in Patients With Ischemic Cardiomyopathy and Implantable Cardioverter-DefibrillatorCirculation: Cardiovascular Imaging, 2009
- Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial InfarctionCirculation, 2008
- Model of reentrant ventricular tachycardia based on infarct border zone geometry predicts reentrant circuit features as determined by activation mappingHeart Rhythm, 2007
- Infarct Tissue Heterogeneity by Magnetic Resonance Imaging Identifies Enhanced Cardiac Arrhythmia Susceptibility in Patients With Left Ventricular DysfunctionCirculation, 2007
- Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging studyThe Lancet, 2003
- Catheter Ablation in Patients With Multiple and Unstable Ventricular Tachycardias After Myocardial InfarctionCirculation, 2001
- Linear Ablation Lesions for Control of Unmappable Ventricular Tachycardia in Patients With Ischemic and Nonischemic CardiomyopathyCirculation, 2000
- Relationship of MRI Delayed Contrast Enhancement to Irreversible Injury, Infarct Age, and Contractile FunctionCirculation, 1999