This research is supported by a grant from Fondation Leducq (09 CVD 03).
Integration of Merged Delayed-Enhanced Magnetic Resonance Imaging and Multidetector Computed Tomography for the Guidance of Ventricular Tachycardia Ablation: A Pilot Study
Version of Record online: 17 DEC 2012
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 4, pages 419–426, April 2013
How to Cite
COCHET, H., KOMATSU, Y., SACHER, F., JADIDI, A. S., SCHERR, D., RIFFAUD, M., DERVAL, N., SHAH, A., ROTEN, L., PASCALE, P., RELAN, J., SERMESANT, M., AYACHE, N., MONTAUDON, M., LAURENT, F., HOCINI, M., HAÏSSAGUERRE, M. and JAÏS, P. (2013), Integration of Merged Delayed-Enhanced Magnetic Resonance Imaging and Multidetector Computed Tomography for the Guidance of Ventricular Tachycardia Ablation: A Pilot Study. Journal of Cardiovascular Electrophysiology, 24: 419–426. doi: 10.1111/jce.12052
Pr. Jaïs is a speaker and consultant for St. Jude Medical and Biosense Webster. Pr. Haissaguerre is a consultant for Biosense Webster. Dr. Sacher is a consultant for Biosense Webster. Other authors: No disclosures.
- Issue online: 1 APR 2013
- Version of Record online: 17 DEC 2012
- Accepted manuscript online: 9 NOV 2012 09:32AM EST
- Manuscript received 25 June 2012; Revised manuscript received 2 October 2012; Accepted for publication 12 October 2012.
- catheter ablation;
- computed tomography;
- myocardial infarction;
- ventricular tachycardia
MDCT/MRI Fusion for the Guidance of VT Ablation. Background: Delayed enhancement (DE) MRI can assess the fibrotic substrate of scar-related VT. MDCT has the advantage of inframillimetric spatial resolution and better 3D reconstructions. We sought to evaluate the feasibility and usefulness of integrating merged MDCT/MRI data in 3D-mapping systems for structure–function assessment and multimodal guidance of VT mapping and ablation.
Methods: Nine patients, including 3 ischemic cardiomyopathy (ICM), 3 nonischemic cardiomyopathy (NICM), 2 myocarditis, and 1 redo procedure for idiopathic VT, underwent MRI and MDCT before VT ablation. Merged MRI/MDCT data were integrated in 3D-mapping systems and registered to high-density endocardial and epicardial maps. Low-voltage areas (<1.5 mV) and local abnormal ventricular activities (LAVA) during sinus rhythm were correlated to DE at MRI, and wall-thinning (WT) at MDCT.
Results: Endocardium and epicardium were mapped with 391 ± 388 and 1098 ± 734 points per map, respectively. Registration of MDCT allowed visualization of coronary arteries during epicardial mapping/ablation. In the idiopathic patient, integration of MRI data identified previously ablated regions. In ICM patients, both DE at MRI and WT at MDCT matched areas of low voltage (overlap 94 ± 6% and 79 ± 5%, respectively). In NICM patients, wall-thinning areas matched areas of low voltage (overlap 63 ± 21%). In patients with myocarditis, subepicardial DE matched areas of epicardial low voltage (overlap 92 ± 12%). A total number of 266 LAVA sites were found in 7/9 patients. All LAVA sites were associated to structural substrate at imaging (90% inside, 100% within 18 mm).
Conclusion: The integration of merged MDCT and DEMRI data is feasible and allows combining substrate assessment with high-spatial resolution to better define structure–function relationship in scar-related VT. (J Cardiovasc Electrophysiol, Vol. 24, pp. 419-426, April 2013)