Contrast-enhanced cardiac MRI before VT ablation in ICD patients was safe, with unchanged ICD parameters (P>0.05), and allowed accurate 3D scar map integration (accuracy 3.9±1.8 mm).
Observational (n=22)
Does contrast-enhanced cardiac MRI with 3D scar reconstruction facilitate substrate-guided VT ablation in patients with ICDs?
Contrast-enhanced cardiac MRI can be safely performed in selected ICD patients to integrate 3D scar maps into clinical mapping systems, providing supplementary anatomic guidance to facilitate substrate-guided VT ablation.
p-value: p=>0.05
BACKGROUND: Substrate-guided ablation of ventricular tachycardia (VT) in patients with implanted cardioverter-defibrillators (ICDs) relies on voltage mapping to define the scar and border zone. An integrated 3D scar reconstruction from late gadolinium enhancement (LGE) MRI could facilitate VT ablations. METHODS AND RESULTS: Twenty-two patients with ICD underwent contrast-enhanced cardiac MRI with a specific absorption rate of 0.05). ICD imaging artifacts were most prominent in the anterior wall and allowed full and partial assessment of LGE in 9±4 and 12±3 of 17 segments, respectively. In 14 patients with LGE, a 3D scar model was reconstructed and successfully registered with the clinical mapping system (accuracy, 3.9±1.8 mm). Using receiver operating characteristic curves, bipolar and unipolar voltages of 1.49 and 4.46 mV correlated best with endocardial MRI scar. Scar visualization allowed the elimination of falsely low voltage recordings (suboptimal catheter contact) in 4.1±1.9% of 2 mm resulted in >1.5-mV voltage recordings despite up to 63% transmural midmyocardial scar successfully ablated with MRI guidance. All successful ablation sites demonstrated LGE (transmurality, 68±26%) and were located within 10 mm of transition zones to 0% to 25% scar in 71%. CONCLUSIONS: Contrast-enhanced cardiac MRI can be safely performed in selected patients with ICDs and allows the integration of detailed 3D scar maps into clinical mapping systems, providing supplementary anatomic guidance to facilitate substrate-guided VT ablations.
Dickfeld et al. (2011) conducted an observational in Ventricular tachycardia in patients with implanted cardioverter-defibrillators (n=22). Contrast-enhanced cardiac MRI with 3D scar reconstruction was evaluated on Change in ICD parameters and 3D scar model registration accuracy (p=>0.05). Contrast-enhanced cardiac MRI before VT ablation in ICD patients was safe, with unchanged ICD parameters (P>0.05), and allowed accurate 3D scar map integration (accuracy 3.9±1.8 mm).
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