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

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

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 electrogra...

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Bibliographic Details
Published in:European heart journal Vol. 32; no. 1; pp. 104 - 114
Main Authors: WIJNMAATEN, Adrianus P, VAN DER GEEST, Rob J, VAN HULS VAN TAXIS, Carine F. B, SIEBELINK, Hans-Marc J, KROFT, Lucia J. M, BAX, Jeroen J, REIBER, Johan H. C, SCHATIJ, Martin J, ZEPPENFELD, Katja
Format: Journal Article
Language:English
Published: Oxford Oxford University Press 2011
Subjects:
Aged
Biological and medical sciences
Cardiac dysrhythmias
Cardiology. Vascular system
Catheter Ablation
Cicatrix - pathology
Classical genetics, quantitative genetics, hybrids
Coronary heart disease
Electrophysiologic Techniques, Cardiac
Feasibility Studies
Female
Fundamental and applied biological sciences. Psychology
Genetics of eukaryotes. Biological and molecular evolution
Heart
Human
Humans
Imaging, Three-Dimensional
Magnetic Resonance Angiography
Male
Medical sciences
Middle Aged
Myocardial Infarction - pathology
Myocarditis. Cardiomyopathies
Sensitivity and Specificity
Tachycardia, Ventricular - pathology
Tachycardia, Ventricular - therapy
Myocardial infarction
Arrhythmia
Image processing
Scar
Catheter ablation
Catheter
Cardiovascular disease
Mapping
Myocardial disease
Voltage
Cardiology
Contrast media
Genetic mapping
Human
Cartography
Head
Characteristic
Patient
Ventricular tachycardia
Real time
Coronary heart disease
Ablation
Nuclear magnetic resonance imaging
Magnetic resonance imaging
Characteristics
Medical imagery
Tachyarrhythmias
Circulatory system
Comparative study
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Summary: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.
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ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehq345