Assessment of ventricular tachycardia scar substrate by intracardiac echocardiography

Ayman Hussein, Alejandro Jimenez, Ghada Ahmad, Olurotimi Mesubi, Thomas Klein, Gagandeep Gurm, Hiroko Beck, Omar Shams, Vincent See, Anastasios Saliaris, Stephen Shorofsky, Timm Dickfeld

Research output: Contribution to journalArticle

Abstract

Background Intracardiac echocardiography (ICE) is increasingly used to guide complex ablation procedures. This study aimed to assess the scar substrate of ventricular tachycardia (VT) by ICE in patients undergoing VT ablation. Methods In 22 patients undergoing VT ablation (10 ischemic, 12 nonischemic), the Biosense CARTOSOUND module (Biosense Webster, Diamond Bar, CA, USA) was used for three-dimensional reconstruction of the ventricles. The characteristics and appearance with ICE imaging of voltage-defined scar zones (bipolar voltage 1.5 mV) on electroanatomic maps were evaluated. The standard image analysis software Image J (National Institutes of Health, Bethesda, MD, USA) was used to analyze signal intensity (mean pixel signal intensity unit [SIU]) and heterogeneity (standard deviation of signal intensity in analyzed area) on ICE images. Results A total of 83 myocardial areas were analyzed from two-dimensional ICE images (15 scars, 31 border zones, and 37 normal). Voltage-defined scar zones had increased signal intensities compared to border zones (149 SIU vs 104 SIU, P <0.0001) and normal myocardium (88 SIU, P <0.0001). Border zones were more likely to have heterogeneous densities compared to normal myocardium (standard deviation of signal intensity 20 SIU vs 12 SIU, P <0.0001). In receiver-operator characteristic analyses, signal intensity ≥137 SIU differentiated scar from nonscar zones (area under curve 0.91, P <0.0001). Software-based color enhancement of areas with signal intensity ≥137 SIU allowed identification of the VT substrate in all 15 patients with voltage-defined scar zones. Conclusions ICE provides important information about the VT anatomical substrate and may have potential to identify areas of scarred myocardium.

Original languageEnglish (US)
Pages (from-to)412-421
Number of pages10
JournalPACE - Pacing and Clinical Electrophysiology
Volume37
Issue number4
DOIs
StatePublished - 2014
Externally publishedYes

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Ventricular Tachycardia
Cicatrix
Echocardiography
Myocardium
Software
Diamond
National Institutes of Health (U.S.)
Area Under Curve
Color

Keywords

  • ablation
  • intracardiac echocardiography
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Assessment of ventricular tachycardia scar substrate by intracardiac echocardiography. / Hussein, Ayman; Jimenez, Alejandro; Ahmad, Ghada; Mesubi, Olurotimi; Klein, Thomas; Gurm, Gagandeep; Beck, Hiroko; Shams, Omar; See, Vincent; Saliaris, Anastasios; Shorofsky, Stephen; Dickfeld, Timm.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 37, No. 4, 2014, p. 412-421.

Research output: Contribution to journalArticle

Hussein, A, Jimenez, A, Ahmad, G, Mesubi, O, Klein, T, Gurm, G, Beck, H, Shams, O, See, V, Saliaris, A, Shorofsky, S & Dickfeld, T 2014, 'Assessment of ventricular tachycardia scar substrate by intracardiac echocardiography', PACE - Pacing and Clinical Electrophysiology, vol. 37, no. 4, pp. 412-421. https://doi.org/10.1111/pace.12278
Hussein, Ayman ; Jimenez, Alejandro ; Ahmad, Ghada ; Mesubi, Olurotimi ; Klein, Thomas ; Gurm, Gagandeep ; Beck, Hiroko ; Shams, Omar ; See, Vincent ; Saliaris, Anastasios ; Shorofsky, Stephen ; Dickfeld, Timm. / Assessment of ventricular tachycardia scar substrate by intracardiac echocardiography. In: PACE - Pacing and Clinical Electrophysiology. 2014 ; Vol. 37, No. 4. pp. 412-421.
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abstract = "Background Intracardiac echocardiography (ICE) is increasingly used to guide complex ablation procedures. This study aimed to assess the scar substrate of ventricular tachycardia (VT) by ICE in patients undergoing VT ablation. Methods In 22 patients undergoing VT ablation (10 ischemic, 12 nonischemic), the Biosense CARTOSOUND module (Biosense Webster, Diamond Bar, CA, USA) was used for three-dimensional reconstruction of the ventricles. The characteristics and appearance with ICE imaging of voltage-defined scar zones (bipolar voltage 1.5 mV) on electroanatomic maps were evaluated. The standard image analysis software Image J (National Institutes of Health, Bethesda, MD, USA) was used to analyze signal intensity (mean pixel signal intensity unit [SIU]) and heterogeneity (standard deviation of signal intensity in analyzed area) on ICE images. Results A total of 83 myocardial areas were analyzed from two-dimensional ICE images (15 scars, 31 border zones, and 37 normal). Voltage-defined scar zones had increased signal intensities compared to border zones (149 SIU vs 104 SIU, P <0.0001) and normal myocardium (88 SIU, P <0.0001). Border zones were more likely to have heterogeneous densities compared to normal myocardium (standard deviation of signal intensity 20 SIU vs 12 SIU, P <0.0001). In receiver-operator characteristic analyses, signal intensity ≥137 SIU differentiated scar from nonscar zones (area under curve 0.91, P <0.0001). Software-based color enhancement of areas with signal intensity ≥137 SIU allowed identification of the VT substrate in all 15 patients with voltage-defined scar zones. Conclusions ICE provides important information about the VT anatomical substrate and may have potential to identify areas of scarred myocardium.",
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T1 - Assessment of ventricular tachycardia scar substrate by intracardiac echocardiography

AU - Hussein, Ayman

AU - Jimenez, Alejandro

AU - Ahmad, Ghada

AU - Mesubi, Olurotimi

AU - Klein, Thomas

AU - Gurm, Gagandeep

AU - Beck, Hiroko

AU - Shams, Omar

AU - See, Vincent

AU - Saliaris, Anastasios

AU - Shorofsky, Stephen

AU - Dickfeld, Timm

PY - 2014

Y1 - 2014

N2 - Background Intracardiac echocardiography (ICE) is increasingly used to guide complex ablation procedures. This study aimed to assess the scar substrate of ventricular tachycardia (VT) by ICE in patients undergoing VT ablation. Methods In 22 patients undergoing VT ablation (10 ischemic, 12 nonischemic), the Biosense CARTOSOUND module (Biosense Webster, Diamond Bar, CA, USA) was used for three-dimensional reconstruction of the ventricles. The characteristics and appearance with ICE imaging of voltage-defined scar zones (bipolar voltage 1.5 mV) on electroanatomic maps were evaluated. The standard image analysis software Image J (National Institutes of Health, Bethesda, MD, USA) was used to analyze signal intensity (mean pixel signal intensity unit [SIU]) and heterogeneity (standard deviation of signal intensity in analyzed area) on ICE images. Results A total of 83 myocardial areas were analyzed from two-dimensional ICE images (15 scars, 31 border zones, and 37 normal). Voltage-defined scar zones had increased signal intensities compared to border zones (149 SIU vs 104 SIU, P <0.0001) and normal myocardium (88 SIU, P <0.0001). Border zones were more likely to have heterogeneous densities compared to normal myocardium (standard deviation of signal intensity 20 SIU vs 12 SIU, P <0.0001). In receiver-operator characteristic analyses, signal intensity ≥137 SIU differentiated scar from nonscar zones (area under curve 0.91, P <0.0001). Software-based color enhancement of areas with signal intensity ≥137 SIU allowed identification of the VT substrate in all 15 patients with voltage-defined scar zones. Conclusions ICE provides important information about the VT anatomical substrate and may have potential to identify areas of scarred myocardium.

AB - Background Intracardiac echocardiography (ICE) is increasingly used to guide complex ablation procedures. This study aimed to assess the scar substrate of ventricular tachycardia (VT) by ICE in patients undergoing VT ablation. Methods In 22 patients undergoing VT ablation (10 ischemic, 12 nonischemic), the Biosense CARTOSOUND module (Biosense Webster, Diamond Bar, CA, USA) was used for three-dimensional reconstruction of the ventricles. The characteristics and appearance with ICE imaging of voltage-defined scar zones (bipolar voltage 1.5 mV) on electroanatomic maps were evaluated. The standard image analysis software Image J (National Institutes of Health, Bethesda, MD, USA) was used to analyze signal intensity (mean pixel signal intensity unit [SIU]) and heterogeneity (standard deviation of signal intensity in analyzed area) on ICE images. Results A total of 83 myocardial areas were analyzed from two-dimensional ICE images (15 scars, 31 border zones, and 37 normal). Voltage-defined scar zones had increased signal intensities compared to border zones (149 SIU vs 104 SIU, P <0.0001) and normal myocardium (88 SIU, P <0.0001). Border zones were more likely to have heterogeneous densities compared to normal myocardium (standard deviation of signal intensity 20 SIU vs 12 SIU, P <0.0001). In receiver-operator characteristic analyses, signal intensity ≥137 SIU differentiated scar from nonscar zones (area under curve 0.91, P <0.0001). Software-based color enhancement of areas with signal intensity ≥137 SIU allowed identification of the VT substrate in all 15 patients with voltage-defined scar zones. Conclusions ICE provides important information about the VT anatomical substrate and may have potential to identify areas of scarred myocardium.

KW - ablation

KW - intracardiac echocardiography

KW - ventricular tachycardia

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