Usefulness of contrast-enhanced cardiac magnetic resonance in identifying the ventricular arrhythmia substrate and the approach needed for ablation
Usefulness of contrast-enhanced cardiac magnetic resonance in identifying the ventricular arrhythmia substrate and the approach needed for ablation
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DOI：
10.1093/eurheartj/eht510
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发表时间：
2014-05-01
影响因子：
39.3
通讯作者：
Berruezo, Antonio
中科院分区：
文献类型：
--
作者：
Andreu, David;Tomas Ortiz-Perez, Jose;Berruezo, Antonio
目的 室性心律失常 (VA) 的心内膜与心外膜起源可以通过详细的心电图 (ECG) 分析来推断。然而，尽管心电图具有临床用途，但它也有局限性。或者，可以通过对比增强心脏磁共振 (ce-CMR) 来识别维持 VA 的疤痕组织。本研究的目的是确定分析心室中疤痕组织的存在和分布模式以确定 VA 起源部位和所需消融方法的临床价值。 方法和结果 在 80 名非特发性 VA 患者的指数消融手术之前进行了 ce-CMR 研究。每个心室节段的过度增强（HE）被编码为缺席、心内膜下、透壁、心肌中部或心外膜。心内膜或心外膜 VA 起源部位也根据消融所需的方法进行分配。 77 名 (96.3%) 患者的临床 VA 被成功消融，所有患者在 ce-CMR 上均显示 HE。在成功消融临床室性心动过速的节段中，3 例 (3.9%) 患者不存在 HE，19 例 (24.7%) 患者不存在心内膜下，36 例 (46.7%) 不存在透壁性HE，8 例 (10.4%) 不存在心肌中部，11 例 (14.3%) 患者不存在心外膜下。 3 名（6.1%）缺血性患者和 12 名（42.9%）非缺血性患者需要对 VA 指数进行心外膜消融。成功消融段中心外膜下 HE 的存在对于预测 VA 的心外膜起源具有 84.6% 的敏感性和 100% 的特异性。 结论 对比增强心脏磁共振有助于定位非特发性 VA 的目标消融基底，并有助于规划所需的入路，特别是在非缺血患者中。
Aims The endocardial vs. epicardial origin of ventricular arrhythmia (VA) can be inferred from detailed electrocardiogram (ECG) analysis. However, despite its clinical usefulness, ECG has limitations. Alternatively, scarred tissue sustaining VAs can be identified by contrast-enhanced cardiac magnetic resonance (ce-CMR). The objective of this study was to determine the clinical value of analysing the presence and distribution pattern of scarred tissue in the ventricles to identify the VA site of origin and the ablation approach required.Methods and results A ce-CMR study was carried out before the index ablation procedure in a cohort of 80 patients with non-idiopathic VA. Hyper-enhancement (HE) in each ventricular segment was coded as absent, subendocardial, transmural, mid-myocardial, or epicardial. The endocardial or epicardial VA site of origin was also assigned according to the approach needed for ablation. The clinical VA was successfully ablated in 77 (96.3%) patients, all of them showing HE on ce-CMR. In segments with successful ablation of the clinical ventricular tachycardia, HE was absent in 3 (3.9%) patients, subendocardial in 19 (24.7%), transmural in 36 (46.7%), mid-myocardial in 8 (10.4%), and subepicardial in 11 (14.3%) patients. Epicardial ablation of the index VA was necessary in 3 (6.1%) ischaemic and 12 (42.9%) non-ischaemic patients. The presence of subepicardial HE in the successful ablation segment had 84.6% sensitivity and 100% specificity in predicting an epicardial origin of \ the VA.Conclusion Contrast-enhanced cardiac magnetic resonance is helpful to localize the target ablation substrate of non-idiopathic VA and also to plan the approach needed, especially in non-ischaemic patients.