MRI-Guided Ventricular Tachycardia Ablation Integration of Late Gadolinium-Enhanced 3D Scar in Patients With Implantable Cardioverter-Defibrillators
MRI-Guided Ventricular Tachycardia Ablation Integration of Late Gadolinium-Enhanced 3D Scar in Patients With Implantable Cardioverter-Defibrillators
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DOI：
10.1161/circep.110.958744
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发表时间：
2011-04-01
影响因子：
8.4
通讯作者：
Jeudy, Jean
中科院分区：
文献类型：
--
作者：
Dickfeld, Timm;Tian, Jing;Jeudy, Jean
植入心律转复除颤器 (ICD) 的患者的室性心动过速 (VT) 背景基质引导消融依靠电压映射来定义疤痕和边界区域。晚期钆增强 (LGE) MRI 的综合 3D 疤痕重建可以促进 VT 消融。方法和结果 - 22 名 ICD 患者在 VT 消融前接受了对比增强心脏 MRI，比吸收率 < 2.0 W/kg。设备询问表明 ICD 参数在随访前、随访后或 68 +/- 21 天随访时未发生变化 (P > 0.05)。 ICD 成像伪影在前壁中最为明显，并允许分别对 17 个节段中的 9 +/- 4 和 12 +/- 3 个 LGE 进行全面和部分评估。在 14 名 LGE 患者中，重建了 3D 疤痕模型并成功在临床测绘系统中注册（精度为 3.9 +/- 1.8 毫米）。使用受试者工作特征曲线，1.49 和 4.46 mV 的双极和单极电压与心内膜 MRI 疤痕的相关性最佳。疤痕可视化可以消除 < 1.5 mV 映射点中 4.1 +/- 1.9% 的错误低电压记录（导管接触不良）。疤痕边界区域的显示可以识别出色的起搏标测部位，64% 的患者仅进行有限的电压标测。尽管高达 63% 的透壁中层心肌疤痕在 MRI 引导下成功消融，但 > 2 mm 的存活心内膜导致 > 1.5 mV 的电压记录。所有成功的消融部位都显示出 LGE（透壁性，68 +/- 26%），并且位于 71% 的 0% 至 25% 疤痕过渡区的 10 毫米内。结论 - 对比增强心脏 MRI 可以在选定的 ICD 患者中安全地进行，并允许将详细的 3D 疤痕图集成到临床测绘系统中，提供补充解剖指导，以促进基底引导的 VT 消融。 （循环心律失常电生理学。2011；4：172-184。）
Background-Substrate-guided ablation of ventricular tachycardia (VT) in patients with implanted cardioverter-defibrillators (ICDs) relies on voltage mapping to define the scar and border zone. An integrated 3D scar reconstruction from late gadolinium enhancement (LGE) MRI could facilitate VT ablations.Methods and Results-Twenty-two patients with ICD underwent contrast-enhanced cardiac MRI with a specific absorption rate of < 2.0 W/kg before VT ablation. Device interrogation demonstrated unchanged ICD parameters immediately before, after, or at 68 +/- 21 days follow-up (P > 0.05). ICD imaging artifacts were most prominent in the anterior wall and allowed full and partial assessment of LGE in 9 +/- 4 and 12 +/- 3 of 17 segments, respectively. In 14 patients with LGE, a 3D scar model was reconstructed and successfully registered with the clinical mapping system (accuracy, 3.9 +/- 1.8 mm). Using receiver operating characteristic curves, bipolar and unipolar voltages of 1.49 and 4.46 mV correlated best with endocardial MRI scar. Scar visualization allowed the elimination of falsely low voltage recordings (suboptimal catheter contact) in 4.1 +/- 1.9% of < 1.5-mV mapping points. Display of scar border zone allowed identification of excellent pace mapping sites, with only limited voltage mapping in 64% of patients. Viable endocardium of > 2 mm resulted in > 1.5-mV voltage recordings despite up to 63% transmural midmyocardial scar successfully ablated with MRI guidance. All successful ablation sites demonstrated LGE (transmurality, 68 +/- 26%) and were located within 10 mm of transition zones to 0% to 25% scar in 71%.Conclusions-Contrast-enhanced cardiac MRI can be safely performed in selected patients with ICDs and allows the integration of detailed 3D scar maps into clinical mapping systems, providing supplementary anatomic guidance to facilitate substrate-guided VT ablations. (Circ Arrhythm Electrophysiol. 2011;4:172-184.)