Three-dimensional architecture of scar and conducting channels based on high resolution ce-CMR: insights for ventricular tachycardia ablation
SourceCirculation : Arrhythmia and Electrophysiology, 6, 3, (2013), pp. 528-37
Article / Letter to editor
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Circulation : Arrhythmia and Electrophysiology
SubjectNCEBP 14: Cardiovascular diseases
BACKGROUND: Conducting channels are the target for ventricular tachycardia (VT) ablation. Conducting channels could be identified with contrast enhanced-cardiac magnetic resonance (ce-CMR) as border zone (BZ) corridors. A 3-dimensional (3D) reconstruction of the ce-CMR could allow visualization of the 3D structure of these BZ channels. METHODS AND RESULTS: We included 21 patients with healed myocardial infarction and VT. A 3D high-resolution 3T ce-CMR was performed before CARTO-guided VT ablation. The left ventricular wall was segmented and characterized using a pixel signal intensity algorithm at 5 layers (endocardium, 25%, 50%, 75%, epicardium). A 3D color-coded shell map was obtained for each layer to depict the scar core and BZ distribution. The presence/characteristics of BZ channels were registered for each layer. Scar area decreased progressively from endocardium to epicardium (scar area/left ventricular area: 34.0+/-17.4% at endocardium, 24.1+/-14.7% at 25%, 16.3+/-12.1% at 50%, 13.1+/-10.4 at 75%, 12.1+/-9.3% at epicardium; P<0.01). Forty-five BZ channels (2.1+/-1.0 per patient, 23.7+/-12.0 mm length, mean minimum width 2.5+/-1.5 mm) were identified, 85% between the endocardium and 50% shell and 76% present in >/=1 layer. The ce-CMR-defined BZ channels identified 74% of the critical isthmus of clinical VTs and 50% of all the conducting channels identified in electroanatomic maps. CONCLUSIONS: Scar area in patients with healed myocardial infarction decreases from the endocardium to the epicardium. BZ channels, more commonly seen in the endocardium, display a 3D structure within the myocardial wall that can be depicted with ce-CMR. The use of ce-CMR-derived maps to guide VT ablation warrants further investigation.
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