Dataset Information

Scar characteristics derived from two- and three-dimensional reconstructions of cardiac contrast-enhanced magnetic resonance images: Relationship to ventricular tachycardia inducibility and ablation success.

ABSTRACT:

Background

The relationship between cardiac contrast-enhanced magnetic resonance imaging (CE-MRI)-derived scar characteristics and substrate for ventricular tachycardia (VT) in patients with structural heart disease (SHD) has not been fully investigated.

Methods

This study included 51 patients (mean age, 63.3±15.1 years) who underwent CE-MRI with SHD and VT induction testing before ablation. Late gadolinium-enhanced (LGE) regions on MRI slices were quantified by thresholding techniques. Signal intensities (SIs) 2-6 SDs above the mean SI of the remote left ventricular (LV) myocardium were considered as scar border zones, and SI>6 SDs, as scar zone, and the scar characteristics related to VT inducibility and successful ablation via endocardial approaches were evaluated.

Results

The proportion of the total CE-MRI-derived scar border zone in the inducible VT group was significantly greater than that in the non-inducible VT group (26.3±9.9% vs. 19.2±7.8%, respectively, P=0.0323). The LV endocardial scar zone to total LV myocardial scar zone ratio in patients whose ablation was successful was significantly greater than that in those whose ablation was unsuccessful (0.61±0.11 vs. 0.48±0.12, respectively, P=0.0042). Most successful ablation sites were located adjacent to CE-MRI-derived scar border zones.

Conclusions

By CE-MRI, we were able to characterize not only the scar, but also its location and heterogeneity, and those features seemed to be related to VT inducibility and successful ablation from an endocardial site.

SUBMITTER: Sonoda K

PROVIDER: S-EPMC5634683 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Scar characteristics derived from two- and three-dimensional reconstructions of cardiac contrast-enhanced magnetic resonance images: Relationship to ventricular tachycardia inducibility and ablation success.

Sonoda Kazumasa K Okumura Yasuo Y Watanabe Ichiro I Nagashima Koichi K Mano Hiroaki H Kogawa Rikitake R Yamaguchi Naoko N Takahashi Keiko K Iso Kazuki K Ohkubo Kimie K Nakai Toshiko T Kunimoto Satoshi S Hirayama Atsushi A

Journal of arrhythmia 20161231 5

<h4>Background</h4>The relationship between cardiac contrast-enhanced magnetic resonance imaging (CE-MRI)-derived scar characteristics and substrate for ventricular tachycardia (VT) in patients with structural heart disease (SHD) has not been fully investigated.<h4>Methods</h4>This study included 51 patients (mean age, 63.3±15.1 years) who underwent CE-MRI with SHD and VT induction testing before ablation. Late gadolinium-enhanced (LGE) regions on MRI slices were quantified by thresholding techn ...[more]

PMID: 29021848

Similar Datasets

Project description:BackgroundDynamic functional substrate mapping of scar-related ventricular tachycardia offers better identification of ablation targets with limited ablation lesions. Several functional substrate mapping approaches have been proposed, including decrement-evoked potential (DEEP) mapping. The aim of our study was to compare the short- and long-term efficacy of a DEEP-guided versus a fixed-substrate-guided strategy for the ablation of scar-related ventricular tachycardia (VT).ResultsForty consecutive patients presenting for ablation of scar-related VT were randomized to either DEEP-guided or substrate-guided ablation. Late potentials were tagged and ablated in the non-DEEP group, while those in the DEEP group were subjected to RV extrastimulation after a drive train. Only potentials showing significant delay were ablated. Patients were followed for a median duration of 12 months. Twenty patients were allocated to the DEEP group, while the other 20 were allocated to the non-DEEP group. Twelve patients (60%) in the DEEP group had ischemic cardiomyopathy versus 10 patients (50%) in the non-DEEP group (P-value 0.525). Intraoperatively, the median percentage of points with LPs was 19% in the DEEP group and 20.6% in the non-DEEP group. The procedural time was longer in the DEEP group, approaching but missing statistical significance (P-value 0.059). VT non-inducibility was successfully accomplished in 16 patients (80%) in the DEEP group versus 17 patients (85%) in the non-DEEP group (P value 0.597). After a median follow-up duration of 12 months, the VT recurrence rate was 65% in both groups (P value 0.311), with a dropout rate of 10% in the DEEP group. As for the secondary endpoints, all-cause mortality rates were 20% and 25% in the DEEP and non-DEEP groups, respectively (P-value 0.342).ConclusionsDEEP-assisted ablation of scar-related ventricular tachycardia is a feasible strategy with comparable short- and long-term outcomes to a fixed-substrate-based strategy with more specific ablation targets, albeit relatively longer but non-significant procedural times and higher procedural deaths. The imbalance between the study groups in terms of epicardial versus endocardial mapping, although non-significant, warrants the prudent interpretation of our results. Further large-scale randomized trials are recommended.Trial registrationclinicaltrials.gov, registration number: NCT05086510, registered on 28th September 2021, record https://classic.Clinicaltrialsgov/ct2/show/NCT05086510.

Project description:BackgroundRecent advancements in a 3-dimensional mapping system allow for the assessment of detailed conduction properties during sinus rhythm and thus the establishment of a strategy targeting functionally abnormal regions in scar-related ventricular tachycardia (VT). We hypothesized that a rotational activation pattern (RAP) observed in maps during baseline rhythm was associated with the critical location of VT.MethodsWe retrospectively examined the pattern of wavefront propagation during sinus rhythm in patients with scar-related VT. The prevalence and features of the RAP on critical VT circuits were analyzed. RAP was defined as >90° of inward curvature directly above or at the edge of the slow conductive areas.ResultsForty-five VTs in 37 patients (66±15 years old, 89% male, 27% ischemic heart disease) were evaluated. High-density substrate mapping during sinus rhythm (median, 2524 points) was performed using the CARTO3 system before VT induction. Critical sites for reentry were identified by direct termination by radiofrequency catheter ablation in 21 VTs or by pace mapping in 12 VTs. Among them, RAP was present in 70% of the 33 VTs. Four VTs had no RAP at the critical sites during sinus rhythm, but it became visible in the mappings with different wavefront directions. Six VTs, in which intramural or epicardial isthmus was suspected, were rendered noninducible by radiofrequency catheter ablation to the endocardial surface without RAP. RAP had a sensitivity and specificity of 70% and 89%, respectively, for predicting the elements in the critical zone for VT.ConclusionsThe critical zone of VT appears to correspond to an area characterized by the RAP with slow conduction during sinus rhythm, which facilitates targeting areas specific for reentry. However, this may not be applicable to intramural VT substrates and might be affected by the direction of wavefront propagation to the scar during mapping. Graphic Abstract: A graphic abstract is available for this article.

Project description:BACKGROUND:Recent advances have enabled noninvasive mapping of cardiac arrhythmias with electrocardiographic imaging and noninvasive delivery of precise ablative radiation with stereotactic body radiation therapy (SBRT). We combined these techniques to perform catheter-free, electrophysiology-guided, noninvasive cardiac radioablation for ventricular tachycardia. METHODS:We targeted arrhythmogenic scar regions by combining anatomical imaging with noninvasive electrocardiographic imaging during ventricular tachycardia that was induced by means of an implantable cardioverter-defibrillator (ICD). SBRT simulation, planning, and treatments were performed with the use of standard techniques. Patients were treated with a single fraction of 25 Gy while awake. Efficacy was assessed by counting episodes of ventricular tachycardia, as recorded by ICDs. Safety was assessed by means of serial cardiac and thoracic imaging. RESULTS:From April through November 2015, five patients with high-risk, refractory ventricular tachycardia underwent treatment. The mean noninvasive ablation time was 14 minutes (range, 11 to 18). During the 3 months before treatment, the patients had a combined history of 6577 episodes of ventricular tachycardia. During a 6-week postablation "blanking period" (when arrhythmias may occur owing to postablation inflammation), there were 680 episodes of ventricular tachycardia. After the 6-week blanking period, there were 4 episodes of ventricular tachycardia over the next 46 patient-months, for a reduction from baseline of 99.9%. A reduction in episodes of ventricular tachycardia occurred in all five patients. The mean left ventricular ejection fraction did not decrease with treatment. At 3 months, adjacent lung showed opacities consistent with mild inflammatory changes, which had resolved by 1 year. CONCLUSIONS:In five patients with refractory ventricular tachycardia, noninvasive treatment with electrophysiology-guided cardiac radioablation markedly reduced the burden of ventricular tachycardia. (Funded by Barnes-Jewish Hospital Foundation and others.).

Dataset Information

Scar characteristics derived from two- and three-dimensional reconstructions of cardiac contrast-enhanced magnetic resonance images: Relationship to ventricular tachycardia inducibility and ablation success.

Background

Methods

Results

Conclusions

Publications

Scar characteristics derived from two- and three-dimensional reconstructions of cardiac contrast-enhanced magnetic resonance images: Relationship to ventricular tachycardia inducibility and ablation success.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets