Non-invasive detection of slow conduction with cardiac magnetic resonance imaging for ventricular tachycardia ablation

Figures

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  Figure 1. (A) A schematic of an automatic annotation of CCs defined by CMR. Different lengths, widths, and levels of protectedness can be observed for each channel. (B) The correlation with DZs was annotated in every map. In this case, Channel 1 is associated with a DZ in the baseline map, with Channel 3 correlated with a new DZ observed in the remap. (C) Channel 2 is not related to any DZ in this example. CC, conducting channel; CMR, cardiac magnetic resonance; DZ, deceleration zone; ILAM, isochronal late activation mapping.

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  Figure 2. Probability of an association between CMR channels and DZs according to the length of the channel. CCs with a length <10 mm have a probability rate of only 16.7% to detect a DZ. In contrast, CCs that are longer than 25 mm have a probability rate as high as 86.7%. CC, conducting channel; CMR, cardiac magnetic resonance; DZ, deceleration zone.

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  Figure 3. Predictions of the probability of slow conduction with logistic regression for length, mass, protectedness, and cumulative number of affected American Heart Association (AHA) segments.

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  Figure 4. Examples of ILAM and CMR of two patients. In the upper panel, a basal anteroseptal endocardium channel correlated with a DZ in the baseline map. The remap shows how the primary DZ is eliminated, but a new DZ appears (not present in the baseline map), which is also correlated with CMR channels. The lower panel shows the mid-ventricle epicardial channel within the scar correlated with a DZ in the endocardial map. After ablating this primary DZ, a second DZ is shown. This area already showed LAVA in the initial map, but because of the ILAM method, it was not initially detected, and only after ablation of the DZ with the latest EGM was LAVA seen in the ILAM. Interestingly, this new DZ also correlated with CMR channels (DZs are shown in circles). CMR, cardiac magnetic resonance; DZ, deceleration zone; ILAM, isochronal late activation mapping; LAVA, local abnormal ventricular activity.

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  Figure 5. Cardiac magnetic resonance showing two different channels: Channel 1 located exclusively in the first endocardial layer with a shorter length, mass, and protectedness. Channel 2 observed in nine out of nine layers (transmural). ILAM shows a wide area with slow conduction properties correlated with Channel 2. CMR, cardiac magnetic resonance; ILAM, isochronal late activation mapping.

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  Figure 6. A ventricular tachycardia activation map showing an anterior VT circuit (left panel) with diastolic electrograms (circle) correlating with a long CMR channel (right panel). CMR, cardiac magnetic resonance; VT, ventricular tachycardia.