Electroanatomic characterization of post-infarct scars -: Comparison with 3-dimensional myocardial scar reconstruction based on magnetic resonance imaging
Electroanatomic characterization of post-infarct scars -: Comparison with 3-dimensional myocardial scar reconstruction based on magnetic resonance imaging
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DOI：
10.1016/j.jacc.2008.05.038
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发表时间：
2008-09-02
影响因子：
24
通讯作者：
de Chillou, Christian
中科院分区：
文献类型：
--
作者：
Codreanu, Andrei;Odille, Freddy;de Chillou, Christian
目的比较电解剖标测（EAM）和磁共振成像（MRI）延迟对比增强（DCE）对心肌梗死后瘢痕的显示。背景电解剖基底标测是心肌梗死后室性心动过速（VT）消融策略的重要步骤，但这项技术尚未与金标准非侵入性工具进行比较，以了解人类心肌疤痕的地形和透壁程度。方法十名患者（9名男性，年龄71 +/- 10岁）因梗死后室性心动过速消融入院，接受了左心室DCE MRI和窦律三维（3D）（CARTO）EAM（Biosense韦伯斯特、约翰逊和约翰逊、钻石吧、加州）。生成3D彩色编码的MRI重建左心室内膜壳，以显示瘢痕数据（壁内位置和透壁范围）。匹配过程将任何CARTO点分配到其在MRI图上的相应位置。结果电描记图（EGM）形态呈尖峰状、单极或双极EGM电压幅值降低（分别< 6.52和< 1.54 mV）以及双极EGM持续时间延长（> 56 ms）与瘢痕的存在独立相关，无论其在壁内的位置如何。内膜瘢痕的信号减弱程度大于壁内或心外膜瘢痕。所有参数均与透壁瘢痕深度无关。在三分之一的梗死区中，CARTO和MRI图之间的梗死表面明显不匹配。结论窦性心律EAM有助于识别梗死后瘢痕的界限。然而，EAM用于精确瘢痕描绘的准确性是有限的。使用3D MRI数据提供的解剖信息可以规避该限制。
Objectives This study was designed to compare electroanatomic mapping (EAM) and magnetic resonance imaging (MRI) with delayed contrast enhancement (DCE) data for delineation of post-infarct scars.Background Electroanatomic substrate mapping is an important step in the post-infarct ventricular tachycardia (VT) ablation strategy, but this technique has not yet been compared with a gold-standard noninvasive tool informing on the topography and transmural extent of myocardial scars in humans.Methods Ten patients (9 men, age 71 +/- 10 years) admitted for post- infarct VT ablation underwent both a left ventricle DCE MRI and a sinus-rhythm 3-dimensional (3D) (CARTO) EAM (Biosense Webster, Johnson & Johnson, Diamond Bar, California). A 3D color-coded MRI-reconstructed left ventricular endocardial shell was generated to display scar data (intramural location and transmural extent). A matching process allocated any CARTO point to its corresponding position on the MRI map. Electrogram (EGM) characteristics were then evaluated in relation to scar data.Results A spiky EGM morphology, a reduced unipolar or bipolar EGM voltage amplitude (< 6.52 and < 1.54 mV, respectively), as well as a longer bipolar EGM duration (> 56 ms) independently correlated with the presence of scar whatever its intramural position. Endocardial scars had a larger degree of signal reduction than intramural or epicardial scars. None of the parameters was correlated with transmural scar depth. A clear mismatch in infarct surface between CARTO and MRI maps was observed in one-third of infarct zones.Conclusions Sinus-rhythm EAM helps identify the limits of post- infarct scars. However, the accuracy of EAM for precise scar delineation is limited. This limit might be circumvented using anatomical information provided by 3D MRI data.