Magnetic resonance-based anatomical analysis of scar-related ventricular tachycardia -: Implications for catheter ablation
Magnetic resonance-based anatomical analysis of scar-related ventricular tachycardia -: Implications for catheter ablation
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DOI：
10.1161/circresaha.107.158980
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发表时间：
2007-10-26
影响因子：
20.1
通讯作者：
Halperin, Henry R.
中科院分区：
文献类型：
--
作者：
Ashikaga, Hiroshi;Sasano, Tetsuo;Halperin, Henry R.
在疤痕相关的单形性室性心动过速（VT）的导管消融中，基底电压映射用于窦性心律期间电定义疤痕。然而，电定义的疤痕可能不能准确反映解剖疤痕。基于磁共振的疤痕可视化可以阐明疤痕精细结构细节与疤痕相关室速回路之间的三维解剖相关性。我们使用心外膜电极（n=6，心外膜组）在猪慢性心肌梗死模型中使用高分辨率对比增强MRI获得的三维疤痕解剖记录了VT激活序列，心外膜电极与心肌直接接触，并记录了电信号。在另一组动物（n=5，心内膜组）中，我们还使用心内膜篮状导管评估了该模型中心内膜再入的发生率。心肌梗死后10 ~ 12周，所有动物均可重复诱导持续单形室速（n=11）。心外膜组共21例，其中4例（19.0%）为心外膜再入。再入峡的特点是在梗死边界区或梗死上方有相对小体积的活心肌与疤痕组织结合。心内膜组（n=5）共诱发6例室速形态，其中4例（66.7%）为心内膜再入。总之，MRI显示一个空间结构复杂的疤痕，特别是在峡部，在一次缺血发作后具有多种室速形态的基底。基于磁共振的疤痕形态可视化可能有助于术前规划与疤痕相关的、无法映射的室速导管消融。
In catheter ablation of scar-related monomorphic ventricular tachycardia (VT), substrate voltage mapping is used to electrically define the scar during sinus rhythm. However, the electrically defined scar may not accurately reflect the anatomical scar. Magnetic resonance-based visualization of the scar may elucidate the 3D anatomical correlation between the fine structural details of the scar and scar-related VT circuits. We registered VT activation sequence with the 3D scar anatomy derived from high-resolution contrast-enhanced MRI in a swine model of chronic myocardial infarction using epicardial sock electrodes (n=6, epicardial group), which have direct contact with the myocardium where the electrical signal is recorded. In a separate group of animals (n=5, endocardial group), we also assessed the incidence of endocardial reentry in this model using endocardial basket catheters. Ten to 12 weeks after myocardial infarction, sustained monomorphic VT was reproducibly induced in all animals (n=11). In the epicardial group, 21 VT morphologies were induced, of which 4 (19.0%) showed epicardial reentry. The reentry isthmus was characterized by a relatively small volume of viable myocardium bound by the scar tissue at the infarct border zone or over the infarct. In the endocardial group (n=5), 6 VT morphologies were induced, of which 4 (66.7%) showed endocardial reentry. In conclusion, MRI revealed a scar with spatially complex structures, particularly at the isthmus, with substrate for multiple VT morphologies after a single ischemic episode. Magnetic resonance-based visualization of scar morphology would potentially contribute to preprocedural planning for catheter ablation of scar-related, unmappable VT.