Role of 3-Dimensional Architecture of Scar and Surviving Tissue in Ventricular Tachycardia: Insights from High-Resolution Ex Vivo Porcine Models

Farhad Pashakhanloo, Daniel A. Herzka, Henry Halperin, Elliot R. McVeigh, Natalia A. Trayanova

Research output: Contribution to journalArticlepeer-review

Abstract

Background: An improved knowledge of the spatial organization of infarct structure and its contribution to ventricular tachycardia (VT) is important for designing optimal treatments. This study explores the relationship between the 3-dimensional structure of the healed infarct and the VT reentrant pathways in high-resolution models of infarcted porcine hearts. Methods: Structurally detailed models of infarcted ventricles were reconstructed from ex vivo late gadolinium enhancement and diffusion tensor magnetic resonance imaging data of 8 chronically infarcted porcine hearts at submillimeter resolution (0.25×0.25×0.5 mm3). To characterize the 3-dimensional structure of surviving tissue in the zone of infarct, a novel scar-mapped thickness metric was introduced. Further, using the ventricular models, electrophysiological simulations were conducted to determine and analyze the 3-dimensional VT pathways that were established in each of the complex infarct morphologies. Results: The scar-mapped thickness metric revealed the heterogeneous organization of infarct and enabled us to systematically characterize the distribution of surviving tissue thickness in 8 hearts. Simulation results demonstrated the involvement of a subendocardial tissue layer of varying thickness in the majority of VT pathways. Importantly, they revealed that VT pathways are most frequently established within thin surviving tissue structures of thickness ≤2.2 mm (90th percentile) surrounding the scar. Conclusions: The combination of high-resolution imaging data and ventricular simulations revealed the 3-dimensional distribution of surviving tissue surrounding the scar and demonstrated its involvement in VT pathways. The new knowledge obtained in this study contributes toward a better understanding of infarct-related VT.

Original languageEnglish (US)
Article numbere006131
JournalCirculation: Arrhythmia and Electrophysiology
Volume11
Issue number6
DOIs
StatePublished - Jun 1 2018

Keywords

  • arrhythmias, cardiac
  • computer simulation
  • magnetic resonance imaging
  • myocardial infarction
  • tachycardia, ventricular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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