Magnetic resonance-based anatomical analysis of scar-related ventricular tachycardia

Implications for catheter ablation

Hiroshi Ashikaga, Tetsuo Sasano, Jun Dong, M. Muz Zviman, Robert Evers, Bruce Hopenfeld, Valeria Castro, Robert H. Helm, Timm Dickfeld, Saman Nazarian, J. Kevin Donahue, Ronald D Berger, Hugh Calkins, M. Roselle Abraham, Eduardo Marbán, Albert C. Lardo, Elliot R. McVeigh, Henry R Halperin

Research output: Contribution to journalArticle

Abstract

In catheter ablation of scar-related monomorphic ventricular tachycardia (VT), substrate voltage mapping is used to electrically define the scar during sinus rhythm. However, the electrically defined scar may not accurately reflect the anatomical scar. Magnetic resonance-based visualization of the scar may elucidate the 3D anatomical correlation between the fine structural details of the scar and scar-related VT circuits. We registered VT activation sequence with the 3D scar anatomy derived from high-resolution contrast-enhanced MRI in a swine model of chronic myocardial infarction using epicardial sock electrodes (n=6, epicardial group), which have direct contact with the myocardium where the electrical signal is recorded. In a separate group of animals (n=5, endocardial group), we also assessed the incidence of endocardial reentry in this model using endocardial basket catheters. Ten to 12 weeks after myocardial infarction, sustained monomorphic VT was reproducibly induced in all animals (n=11). In the epicardial group, 21 VT morphologies were induced, of which 4 (19.0%) showed epicardial reentry. The reentry isthmus was characterized by a relatively small volume of viable myocardium bound by the scar tissue at the infarct border zone or over the infarct. In the endocardial group (n=5), 6 VT morphologies were induced, of which 4 (66.7%) showed endocardial reentry. In conclusion, MRI revealed a scar with spatially complex structures, particularly at the isthmus, with substrate for multiple VT morphologies after a single ischemic episode. Magnetic resonance-based visualization of scar morphology would potentially contribute to preprocedural planning for catheter ablation of scar-related, unmappable VT.

Original languageEnglish (US)
Pages (from-to)939-947
Number of pages9
JournalCirculation Research
Volume101
Issue number9
DOIs
StatePublished - Oct 2007

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Catheter Ablation
Ventricular Tachycardia
Cicatrix
Magnetic Resonance Spectroscopy
Myocardium
Myocardial Infarction
Anatomy
Electrodes
Swine
Catheters

Keywords

  • Catheter ablation
  • MRI
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Magnetic resonance-based anatomical analysis of scar-related ventricular tachycardia : Implications for catheter ablation. / Ashikaga, Hiroshi; Sasano, Tetsuo; Dong, Jun; Zviman, M. Muz; Evers, Robert; Hopenfeld, Bruce; Castro, Valeria; Helm, Robert H.; Dickfeld, Timm; Nazarian, Saman; Donahue, J. Kevin; Berger, Ronald D; Calkins, Hugh; Abraham, M. Roselle; Marbán, Eduardo; Lardo, Albert C.; McVeigh, Elliot R.; Halperin, Henry R.

In: Circulation Research, Vol. 101, No. 9, 10.2007, p. 939-947.

Research output: Contribution to journalArticle

Ashikaga, H, Sasano, T, Dong, J, Zviman, MM, Evers, R, Hopenfeld, B, Castro, V, Helm, RH, Dickfeld, T, Nazarian, S, Donahue, JK, Berger, RD, Calkins, H, Abraham, MR, Marbán, E, Lardo, AC, McVeigh, ER & Halperin, HR 2007, 'Magnetic resonance-based anatomical analysis of scar-related ventricular tachycardia: Implications for catheter ablation', Circulation Research, vol. 101, no. 9, pp. 939-947. https://doi.org/10.1161/CIRCRESAHA.107.158980
Ashikaga, Hiroshi ; Sasano, Tetsuo ; Dong, Jun ; Zviman, M. Muz ; Evers, Robert ; Hopenfeld, Bruce ; Castro, Valeria ; Helm, Robert H. ; Dickfeld, Timm ; Nazarian, Saman ; Donahue, J. Kevin ; Berger, Ronald D ; Calkins, Hugh ; Abraham, M. Roselle ; Marbán, Eduardo ; Lardo, Albert C. ; McVeigh, Elliot R. ; Halperin, Henry R. / Magnetic resonance-based anatomical analysis of scar-related ventricular tachycardia : Implications for catheter ablation. In: Circulation Research. 2007 ; Vol. 101, No. 9. pp. 939-947.
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abstract = "In catheter ablation of scar-related monomorphic ventricular tachycardia (VT), substrate voltage mapping is used to electrically define the scar during sinus rhythm. However, the electrically defined scar may not accurately reflect the anatomical scar. Magnetic resonance-based visualization of the scar may elucidate the 3D anatomical correlation between the fine structural details of the scar and scar-related VT circuits. We registered VT activation sequence with the 3D scar anatomy derived from high-resolution contrast-enhanced MRI in a swine model of chronic myocardial infarction using epicardial sock electrodes (n=6, epicardial group), which have direct contact with the myocardium where the electrical signal is recorded. In a separate group of animals (n=5, endocardial group), we also assessed the incidence of endocardial reentry in this model using endocardial basket catheters. Ten to 12 weeks after myocardial infarction, sustained monomorphic VT was reproducibly induced in all animals (n=11). In the epicardial group, 21 VT morphologies were induced, of which 4 (19.0{\%}) showed epicardial reentry. The reentry isthmus was characterized by a relatively small volume of viable myocardium bound by the scar tissue at the infarct border zone or over the infarct. In the endocardial group (n=5), 6 VT morphologies were induced, of which 4 (66.7{\%}) showed endocardial reentry. In conclusion, MRI revealed a scar with spatially complex structures, particularly at the isthmus, with substrate for multiple VT morphologies after a single ischemic episode. Magnetic resonance-based visualization of scar morphology would potentially contribute to preprocedural planning for catheter ablation of scar-related, unmappable VT.",
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T2 - Implications for catheter ablation

AU - Ashikaga, Hiroshi

AU - Sasano, Tetsuo

AU - Dong, Jun

AU - Zviman, M. Muz

AU - Evers, Robert

AU - Hopenfeld, Bruce

AU - Castro, Valeria

AU - Helm, Robert H.

AU - Dickfeld, Timm

AU - Nazarian, Saman

AU - Donahue, J. Kevin

AU - Berger, Ronald D

AU - Calkins, Hugh

AU - Abraham, M. Roselle

AU - Marbán, Eduardo

AU - Lardo, Albert C.

AU - McVeigh, Elliot R.

AU - Halperin, Henry R

PY - 2007/10

Y1 - 2007/10

N2 - In catheter ablation of scar-related monomorphic ventricular tachycardia (VT), substrate voltage mapping is used to electrically define the scar during sinus rhythm. However, the electrically defined scar may not accurately reflect the anatomical scar. Magnetic resonance-based visualization of the scar may elucidate the 3D anatomical correlation between the fine structural details of the scar and scar-related VT circuits. We registered VT activation sequence with the 3D scar anatomy derived from high-resolution contrast-enhanced MRI in a swine model of chronic myocardial infarction using epicardial sock electrodes (n=6, epicardial group), which have direct contact with the myocardium where the electrical signal is recorded. In a separate group of animals (n=5, endocardial group), we also assessed the incidence of endocardial reentry in this model using endocardial basket catheters. Ten to 12 weeks after myocardial infarction, sustained monomorphic VT was reproducibly induced in all animals (n=11). In the epicardial group, 21 VT morphologies were induced, of which 4 (19.0%) showed epicardial reentry. The reentry isthmus was characterized by a relatively small volume of viable myocardium bound by the scar tissue at the infarct border zone or over the infarct. In the endocardial group (n=5), 6 VT morphologies were induced, of which 4 (66.7%) showed endocardial reentry. In conclusion, MRI revealed a scar with spatially complex structures, particularly at the isthmus, with substrate for multiple VT morphologies after a single ischemic episode. Magnetic resonance-based visualization of scar morphology would potentially contribute to preprocedural planning for catheter ablation of scar-related, unmappable VT.

AB - In catheter ablation of scar-related monomorphic ventricular tachycardia (VT), substrate voltage mapping is used to electrically define the scar during sinus rhythm. However, the electrically defined scar may not accurately reflect the anatomical scar. Magnetic resonance-based visualization of the scar may elucidate the 3D anatomical correlation between the fine structural details of the scar and scar-related VT circuits. We registered VT activation sequence with the 3D scar anatomy derived from high-resolution contrast-enhanced MRI in a swine model of chronic myocardial infarction using epicardial sock electrodes (n=6, epicardial group), which have direct contact with the myocardium where the electrical signal is recorded. In a separate group of animals (n=5, endocardial group), we also assessed the incidence of endocardial reentry in this model using endocardial basket catheters. Ten to 12 weeks after myocardial infarction, sustained monomorphic VT was reproducibly induced in all animals (n=11). In the epicardial group, 21 VT morphologies were induced, of which 4 (19.0%) showed epicardial reentry. The reentry isthmus was characterized by a relatively small volume of viable myocardium bound by the scar tissue at the infarct border zone or over the infarct. In the endocardial group (n=5), 6 VT morphologies were induced, of which 4 (66.7%) showed endocardial reentry. In conclusion, MRI revealed a scar with spatially complex structures, particularly at the isthmus, with substrate for multiple VT morphologies after a single ischemic episode. Magnetic resonance-based visualization of scar morphology would potentially contribute to preprocedural planning for catheter ablation of scar-related, unmappable VT.

KW - Catheter ablation

KW - MRI

KW - Ventricular tachycardia

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