Feasibility of image-based simulation to estimate ablation target in human ventricular arrhythmia

Hiroshi Ashikaga, Hermenegild Arevalo, Fijoy Vadakkumpadan, Robert C. Blake, Jason D. Bayer, Saman Nazarian, M. Muz Zviman, Harikrishna Tandri, Ronald D. Berger, Hugh Calkins, Daniel A. Herzka, Natalia A. Trayanova, Henry R. Halperin

Research output: Contribution to journalArticle

Abstract

Background Previous studies suggest that magnetic resonance imaging with late gadolinium enhancement (LGE) may identify slowly conducting tissues in scar-related ventricular tachycardia (VT). Objective To test the feasibility of image-based simulation based on LGE to estimate ablation targets in VT. Methods We conducted a retrospective study in 13 patients who had preablation magnetic resonance imaging for scar-related VT ablation. We used image-based simulation to induce VT and estimate target regions according to the simulated VT circuit. The estimated target regions were coregistered with the LGE scar map and the ablation sites from the electroanatomical map in the standard ablation approach. Results In image-based simulation, VT was inducible in 12 (92.3%) patients. All VTs showed macroreentrant propagation patterns, and the narrowest width of estimated target region that an ablation line should span to prevent VT recurrence was 5.0 ± 3.4 mm. Of 11 patients who underwent ablation, the results of image-based simulation and the standard approach were consistent in 9 (82%) patients, where ablation within the estimated target region was associated with acute success (n = 8) and ablation outside the estimated target region was associated with failure (n = 1). In 1 (9%) case, the results of image-based simulation and the standard approach were inconsistent, where ablation outside the estimated target region was associated with acute success. Conclusions The image-based simulation can be used to estimate potential ablation targets of scar-related VT. The image-based simulation may be a powerful noninvasive tool for preprocedural planning of ablation procedures to potentially reduce the procedure time and complication rates.

Original languageEnglish (US)
Pages (from-to)1109-1116
Number of pages8
JournalHeart Rhythm
Volume10
Issue number8
DOIs
StatePublished - Aug 1 2013

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Keywords

  • Cardiac MRI
  • Catheter ablation
  • Computer simulation
  • Image-based simulation
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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