Real-time intracardiac ultrasound mapping correlated more accurately with electroanatomic mapping for left ventricular scar identification than transthoracic echocardiography (86% vs 80%, P=0.046).
Observational (n=18)
Does real-time intracardiac ultrasound (ICE) mapping accurately identify scar tissue compared to electroanatomic mapping and TTE in patients undergoing VT ablation?
Real-time intracardiac ultrasound provides accurate left ventricular scar boundaries that correlate better with electroanatomic mapping than transthoracic echocardiography during VT ablation.
Tasa de eventos absoluta: 86% vs 80%
valor p: p=0.046
BACKGROUND: Ablation of ventricular tachycardia (VT) reduces implantable cardioverter defibrillator shocks. Intracardiac ultrasound (ICE) can visualize and quantify the function of all left ventricular wall segments. We thus hypothesized that ICE could identify scar tissue and provide a guide to facilitate substrate-guided VT ablation. METHODS: Eighteen patients underwent VT ablation with real time ICE mapping from the right atrium and ventricle with online 3D-image reconstruction of scar segments. The left ventricle was also scar mapped by traditional electroanatomic mapping (CARTO) for comparison. Images from these 2 scar mapping techniques were compared to each other as well as to a preprocedure transthoracic echocardiogram. RESULTS: The average age was 65 +/- 12 years and 12 (67%) were male (15 83% had ischemic cardiomyopathy). Two patients (12%) had recurrence of their clinical VT (1 remained on an antiarrhythmic medication, the other had a repeat ablation) over a follow-up of 127 +/- 33 days. No periprocedural or long-term adverse events occurred. A total of 248 wall segments were analyzed. All 3 modalities were concordant in scar identification in 193 (78%) segments. The ICE segments correlated with the electroanatomic map in 213 (86%) segments versus 198 (80%), which correlated with transthoracic echocardiography and electroanatomic mapping (P = 0.046). Specifically, the ICE wall motion scores were closer to the electroanatomic mapping in the basal segments and showed a higher accuracy in ischemic heart disease. CONCLUSION: These data demonstrate that real time ICE images provide accurate chamber geometries and scar boundaries of the left ventricle. These scar borders were more accurate than transthoracic echocardiography and illustrate the feasibility of ICE for substrate-based ablation for VT.
Bunch et al. (Wed,) conducted a observational in Ventricular tachycardia (n=18). Real time intracardiac ultrasound (ICE) mapping vs. Transthoracic echocardiography (TTE) and electroanatomic mapping (CARTO) was evaluated on Correlation of scar identification with electroanatomic mapping in left ventricular wall segments (p=0.046). Real-time intracardiac ultrasound mapping correlated more accurately with electroanatomic mapping for left ventricular scar identification than transthoracic echocardiography (86% vs 80%, P=0.046).