Integration of Merged Delayed-Enhanced Magnetic Resonance Imaging and Multidetector Computed Tomography for the Guidance of Ventricular Tachycardia Ablation: A Pilot Study

J Cardiovasc Electrophysiol. 2013 Apr;24(4):419-26. doi: 10.1111/jce.12052. Epub 2012 Dec 17.

Abstract

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.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Catheter Ablation / methods*
  • Cicatrix / complications
  • Cicatrix / diagnostic imaging
  • Cicatrix / pathology
  • Cicatrix / physiopathology
  • Contrast Media
  • Coronary Angiography / methods*
  • Electrophysiologic Techniques, Cardiac
  • Feasibility Studies
  • Female
  • Fibrosis
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / pathology
  • Heart Ventricles / physiopathology
  • Heart Ventricles / surgery*
  • Heterocyclic Compounds
  • Humans
  • Imaging, Three-Dimensional
  • Iopamidol / analogs & derivatives
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Multidetector Computed Tomography*
  • Organometallic Compounds
  • Pilot Projects
  • Predictive Value of Tests
  • Prospective Studies
  • Radiographic Image Interpretation, Computer-Assisted
  • Tachycardia, Ventricular / diagnostic imaging
  • Tachycardia, Ventricular / etiology
  • Tachycardia, Ventricular / pathology
  • Tachycardia, Ventricular / physiopathology
  • Tachycardia, Ventricular / therapy*
  • Therapy, Computer-Assisted*
  • Treatment Outcome

Substances

  • Contrast Media
  • Heterocyclic Compounds
  • Organometallic Compounds
  • iomeprol
  • gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate
  • Iopamidol