Three-dimensional architecture of scar and conducting channels based on high resolution ce-CMR: Insights for ventricular tachycardia ablation

Juan Fernández-Armenta, Antonio Berruezo, David Andreu, Oscar Camara, Etelvino Silva, Luis Serra, Valeria Barbarito, Luigi Carotenutto, Reinder Evertz, José T. Ortiz-Pérez, Teresa María De Caralt, Rosario Jesús Perea, Marta Sitges, Lluis Mont, Alejandro Frangi, Josep Brugada

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Conducting channels are the target for ventricular tachycardia (VT) ablation. Conducting channels could be identified with contrast enhanced-cardiac magnetic resonance (ce-CMR) as border zone (BZ) corridors. A 3-dimensional (3D) reconstruction of the ce-CMR could allow visualization of the 3D structure of these BZ channels. 

Methods and Results: We included 21 patients with healed myocardial infarction and VT. A 3D high-resolution 3T ce-CMR was performed before CARTO-guided VT ablation. The left ventricular wall was segmented and characterized using a pixel signal intensity algorithm at 5 layers (endocardium, 25%, 50%, 75%, epicardium). A 3D color-coded shell map was obtained for each layer to depict the scar core and BZ distribution. The presence/characteristics of BZ channels were registered for each layer. Scar area decreased progressively from endocardium to epicardium (scar area/left ventricular area: 34.0±17.4% at endocardium, 24.1±14.7% at 25%, 16.3±12.1% at 50%, 13.1±10.4 at 75%, 12.1±9.3% at epicardium; P<0.01). Forty-five BZ channels (2.1±1.0 per patient, 23.7±12.0 mm length, mean minimum width 2.5±1.5 mm) were identified, 85% between the endocardium and 50% shell and 76% present in ≥1 layer. The ce-CMR-defined BZ channels identified 74% of the critical isthmus of clinical VTs and 50% of all the conducting channels identified in electroanatomic maps. 

Conclusions: Scar area in patients with healed myocardial infarction decreases from the endocardium to the epicardium. BZ channels, more commonly seen in the endocardium, display a 3D structure within the myocardial wall that can be depicted with ce-CMR. The use of ce-CMR-derived maps to guide VT ablation warrants further investigation. (Circ Arrhythm Electrophysiol. 2013;6:528-537.).

Original languageEnglish
Pages (from-to)528-537
Number of pages10
JournalCirculation: Arrhythmia and Electrophysiology
Volume6
Issue number3
Early online date17 May 2013
DOIs
Publication statusPublished - Jun 2013

Keywords

  • catheter ablation
  • conducting channels
  • magnetic resonance imaging
  • myocardial infarction
  • ventricular tachycardia
  • MRI

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