Infarct architecture and characteristics on delayed enhanced magnetic resonance imaging and electroanatomic mapping in patients with postinfarction ventricular arrhythmia
Infarct architecture and characteristics on delayed enhanced magnetic resonance imaging and electroanatomic mapping in patients with postinfarction ventricular arrhythmia
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DOI：
10.1016/j.hrthm.2009.02.018
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发表时间：
2009-05-01
期刊：
影响因子：
5.5
通讯作者：
Bogun, Frank
中科院分区：
文献类型：
--
作者：
Desjardins, Benoit;Crawford, Thomas;Bogun, Frank
背景延迟增强磁共振成像(DE-MRI)可用于准确评估心肌梗死瘢痕。目的探讨DE-MRI与EA标测的相关性，以评价心肌梗死后室性心律失常的构筑及其与梗死后室性心律失常的关系。方法对14例心肌梗塞后室性心律失常患者(男性10例；年龄+/-10岁；射血分数0.33+/-0.12)进行窦性心律电解剖标测。所有患者均接受先前的DE-MRI检查。DE-MRI和电针标测数据均在三维空间进行配准。在DE-MRI上评价瘢痕的存在及其透壁性以及瘢痕中心与灰质区，并与EA图进行对比，进一步将EA图的电位图特征与DE-MRI进行相关分析。区分心内膜下心肌的最佳临界值。正常心肌的SCAR双极电压为1.0 mV，单极电压为5.8 mV。DE区与非强化区相比具有明显的电生理特征。梗死后室性心动过速(31/31)和室性早搏(5/5)的关键部位均位于DE区，大部分(71%)位于瘢痕核心区。梗塞后心律失常的关键部位局限于DE区。MRI上的疤痕信息可以选择性地导入到电针标测系统中，以方便标测和消融过程。
BACKGROUND Delayed enhanced magnetic resonance imaging (DE-MRI) can be used for the exact assessment of myocardial infarct scar. Electroanatomic (EA) mapping can identify the sub-endocardial extension of infarcts and is used to identify and eliminate areas critical for postinfarction ventricular arrhythmias.OBJECTIVES The purpose of this study was to correlate DE-MRI with EA mapping in postinfarction patients with ventricular arrhythmias to assess myocardial infarct architecture and its relationship to postinfarction ventricular arrhythmias.METHODS EA mapping during sinus rhythm was performed in 14 postinfarction patients (10 men; age 64 +/- 10 years; ejection fraction 0.33 +/- 0.12) referred for ablation of ventricular arrhythmias. All, patients underwent prior DE-MRI. Both DE-MRI and EA mapping data were registered in three-dimensional space. Presence of scar and its transmurality as well as scar core versus gray zone were assessed on DE-MRI and correlated with EA maps; furthermore, the etectrogram characteristics of the EA map were correlated with the DE-MRI.RESULTS Scar areas as assessed by bipolar and unipollar voltages in the EA map both correlated well with the scar as defined by DE-MRI. The best cutoff value to differentiate subendocardial. scar from normal myocardium was 1.0 mV for bipolar voltage and 5.8 mV for unipolar voltage. Areas with DE had distinct electrophysiologic characteristics compared with nonenhancing sites. All identified sites that were critical for postinfarction ventricular tachycardia (31/31) and premature ventricular complexes (5/5) were located within areas of DE, with most (71%) being located in the core area of the scar.CONCLUSIONS DE-MRI can accurately predict the EA characteristics of corresponding subendocardial locations. Critical sites of postinfarction arrhythmias were confined to areas of DE. The scar information on MRI can be selectively imported into an EA mapping system to facilitate the mapping and ablation procedure.