Key result
Virtual RVI-guided ablation prevents re-entry with ~93% fewer ablation sites compared to clinical ablation.
Why the study?
VT induction during post-MI catheter ablation does not always identify all relevant activation pathways or may not be possible or tolerated.
Does RVI mapping guide virtual ablation to prevent VT induction with fewer ablation sites compared to clinical ablation in post-MI VT patients?
Does RVI mapping guide virtual ablation to prevent VT induction with fewer ablation sites compared to clinical ablation in post-MI VT patients?
RVI mapping in computational models of post-MI VT successfully guided virtual ablation to prevent re-entry using significantly fewer ablation sites and less volume than clinical ablation.
May reduce ablation burden in post-MI VT models; hypothesis-generating for clinical RVI mapping.
BACKGROUND: Ventricular tachycardias (VTs) in patients with myocardial infarction (MI) are often treated with catheter ablation. However, the VT induction during this procedure does not always identify all of the relevant activation pathways or may not be possible or tolerated. The re-entry vulnerability index (RVI) quantifies regional activation-repolarization differences and can detect multiple regions susceptible to re-entry without the need to induce the arrhythmia. OBJECTIVES: This study aimed to further develop and validate the RVI mapping in patient-specific computational models of post-MI VTs. METHODS: Cardiac magnetic resonance imaging data from 4 patients with post-MI VTs were used to induce VTs in a computational electrophysiological model by pacing. The RVI map of a premature beat in each patient model was used to guide virtual ablations. We compared our results with those of clinical ablation in the same patients. RESULTS: Single-site virtual RVI-guided ablation prevented VT induction in 3 of 9 cases. Multisite virtual ablations guided by RVI mapping successfully prevented re-entry in all cases (9 of 9). Overall, virtual ablation required 15-fold fewer ablation sites (235.5 ± 97.4 vs 17.0 ± 6.8) and 2-fold less ablation volume (5.34 ± 1.79 mL vs 2.11 ± 0.65 mL) than the clinical ablation. CONCLUSIONS: RVI mapping allows localization of multiple regions susceptible to re-entry and may help guide VT ablation. RVI mapping does not require the induction of arrhythmia and may result in less ablated myocardial volumes with fewer ablation sites.
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Jelvehgaran et al. (2022) studied Postmyocardial Infarction Ventricular Tachycardia (n=4). Virtual RVI-guided ablation vs. Clinical ablation was evaluated on Prevention of VT induction, ablation sites, and ablation volume. Virtual RVI-guided ablation prevented re-entry in all cases (9 of 9) and required fewer ablation sites (17.0 vs 235.5) and less volume (2.11 vs 5.34 mL) compared to clinical ablation.
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