Value of Cardiac Magnetic Resonance Imaging in Patients With Failed Ablation Procedures for Ventricular Tachycardia
Value of Cardiac Magnetic Resonance Imaging in Patients With Failed Ablation Procedures for Ventricular Tachycardia
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DOI：
10.1111/jce.12848
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发表时间：
2016-02-01
影响因子：
2.7
通讯作者：
Bogun, Frank
中科院分区：
文献类型：
--
作者：
Njeim, Mario;Yokokawa, Miki;Bogun, Frank
背景心肌病患者的室性心动过速（VT）起源于瘢痕组织。如果标测和消融仅限于内膜，则壁内或心外膜瘢痕可能导致无效消融。本研究的目的是探讨是否术前磁共振成像（MRI）是有益的，在确定一个适当的消融strategy.Methods和ResultsA心脏MRI进行了20例消融术失败和心肌病（非缺血性n = 12，缺血性n = 8）的患者endovascular VT消融失败的患者。通过延迟增强MRI（DE-MRI）确定后续消融策略，仅计划在心外膜或壁内游离壁瘢痕患者中进行心外膜剑突下入路。对所有植入或未植入心律转复除颤器（ICD）的患者进行MRI。MRI中瘢痕组织的位置预测了所有患者VT的起源。在9/20例患者中，根据MRI结果进行了心外膜手术。在其余11例有内膜或间隔瘢痕的患者中进行了内膜切除术，1例MRI仅显示伪影。5例患者仍然诱导消融术后，4例患者VT复发，在随访期为17 - 22个月。所有后者的患者有一个壁内瘢痕patterne.ConclusionsImaging与DE-MRI之前VT消融术的患者先前失败的endocardial消融程序是有益的，在确定一个消融策略，有助于专注于感兴趣的区域intraprocedurally，并提供有价值的结果信息。
VT and MRIBackgroundVentricular tachycardia (VT) in patients with cardiomyopathy originates in scar tissue. Intramural or epicardial scar may result in ineffective ablation if mapping and ablation are limited to the endocardium. The purpose of this study was to investigate whether preprocedural magnetic resonance imaging (MRI) is beneficial in patients with failed endocardial VT ablations in determining an appropriate ablation strategy.Methods and ResultsA cardiac MRI was performed in 20 patients with a failed ablation procedure and cardiomyopathy (nonischemic n = 12, ischemic n = 8). A subsequent ablation strategy was determined by a delayed enhanced MRI (DE-MRI) and an epicardial subxyphoid access was planned only in patients with epicardial or intramural free-wall scar. MRIs were performed in all patients with or without an implanted cardioverter defibrillator (ICD). The location of scar tissue in the MRI predicted the origin of VT in all patients. In 9/20 patients an epicardial procedure was performed based on the result of the MRI. An endocardial procedure was performed in the remaining 11 patients who had either endocardial or septal scarring and one patient in whom the MRI only showed artifact. Five patients remained inducible postablation and four patients had VT recurrence within a follow-up period of 17 22 months. All of the latter patients had an intramural scar pattern.ConclusionsImaging with DE-MRI prior to VT ablation in patients with previously failed endocardial ablation procedures is beneficial in identifying an ablation strategy, helps to focus on an area of interest intraprocedurally, and provides valuable outcomes information.