Yamashita Seigo, Sacher Frédéric, Mahida Saagar, Berte Benjamin, Lim Han S, Komatsu Yuki, Amraoui Sana, Denis Arnaud, Derval Nicolas, Laurent François, Sermesant Maxime, Montaudon Michel, Hocini Mélèze, Haïssaguerre Michel, Jaïs Pierre, Cochet Hubert
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
IHU LIRYC-Equipex MUSIC, Université de Bordeaux-Inserm U1045, Pessac, France.
J Cardiovasc Electrophysiol. 2016 Jun;27(6):699-708. doi: 10.1111/jce.12963. Epub 2016 Apr 5.
Although multi-detector computed tomography (MDCT) and cardiac magnetic resonance (CMR) can assess the structural substrate of ventricular tachycardia (VT) in ischemic cardiomyopathy (ICM), non-ICM (NICM), and arrhythmogenic right ventricular cardiomyopathy (ARVC), the usefulness of systematic image integration during VT ablation remains undetermined.
A total of 116 consecutive patients (67 ICM; 30 NICM; 19 ARVC) underwent VT ablation with image integration (MDCT 91%; CMR 30%; both 22%). Substrate was defined as wall thinning on MDCT and late gadolinium-enhancement on CMR in ICM/NICM, and as myocardial hypo-attenuation on MDCT in ARVC. This substrate was compared to mapping and ablation results with the endpoint of complete elimination of local abnormal ventricular activity (LAVA), and the impact of image integration on procedural management was analyzed. Imaging-derived substrate identified 89% of critical VT isthmuses and 85% of LAVA, and was more efficient in identifying LAVA in ICM and ARVC than in NICM (90% and 90% vs. 72%, P < 0.0001), and when defined from CMR than MDCT (ICM: 92% vs. 88%, P = 0.026, NICM: 88% vs. 72%, P < 0.001). Image integration motivated additional mapping and epicardial access in 57% and 33% of patients. Coronary and phrenic nerve integration modified epicardial ablation strategy in 43% of patients. The impact of image integration on procedural management was higher in ARVC/NICM than in ICM (P < 0.01), and higher in case of epicardial approach (P < 0.0001).
Image integration is feasible in large series of patients, provides information on VT substrate, and impacts procedural management, particularly in ARVC/NICM, and in case of epicardial approach.
尽管多排螺旋计算机断层扫描（MDCT）和心脏磁共振成像（CMR）能够评估缺血性心肌病（ICM）、非缺血性心肌病（NICM）和致心律失常性右室心肌病（ARVC）中室性心动过速（VT）的结构基础，但在VT消融过程中系统图像整合的实用性仍未明确。
共有116例连续患者（67例ICM；30例NICM；19例ARVC）接受了图像整合的VT消融治疗（MDCT占91%；CMR占30%；两者均占22%）。在ICM/NICM中，基础病变定义为MDCT上的心肌壁变薄和CMR上的钆延迟强化，而在ARVC中定义为MDCT上的心肌低密度。将该基础病变与标测及消融结果进行比较，以完全消除局部异常心室活动（LAVA）为终点，并分析图像整合对手术操作管理的影响。影像学得出的基础病变识别出89%的关键VT峡部和85%的LAVA，且在识别ICM和ARVC中的LAVA方面比NICM更有效（分别为90%和90%对72%，P<0.0001），并且从CMR定义时比从MDCT定义时更有效（ICM：92%对88%，P = 0.026；NICM：88%对72%，P<0.001）。图像整合促使57%的患者进行额外标测，33%的患者进行心外膜入路。冠状动脉和膈神经整合改变了43%患者的心外膜消融策略。图像整合对手术操作管理的影响在ARVC/NICM中比在ICM中更大（P<0.01），在心外膜入路时影响更大（P<0.0001）。
图像整合在大量患者中是可行的，可提供有关VT基础病变的信息，并影响手术操作管理，尤其是在ARVC/NICM以及心外膜入路的情况下。
