Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.
Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).
Europace. 2020 Apr 1;22(4):598-606. doi: 10.1093/europace/euaa021.
Ventricular tachycardia (VT) substrate-based ablation has become a standard procedure. Electroanatomical mapping (EAM) detects scar tissue heterogeneity and define conduction channels (CCs) that are the ablation target. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is able to depict CCs and increase ablation success. Most patients undergoing VT ablation have an implantable cardioverter-defibrillator (ICD) that can cause image artefacts in LGE-CMR. Recently wideband (WB) LGE-CMR sequence has demonstrated to decrease these artefacts. The aim of this study is to analyse accuracy of WB-LGE-CMR in identifying the CC entrances.
Thirteen consecutive ICD-patients who underwent VT ablation after WB-LGE-CMR were included. Number and location of CC entrances in three-dimensional EAM and in WB-LGE-CMR reconstruction were compared. Concordance was compared with a historical cohort matched by cardiomyopathy, scar location, and age (26 patients) with LGE-CMR prior to ICD and VT ablation. In WB-CMR group, 101 and 93 CC entrances were identified in EAM and WB-LGE-CMR, respectively. In historical cohort, 179 CC entrances were identified in both EAM and LGE-CMR. The EAM/CMR concordance was 85.1% and 92.2% in the WB and historical group, respectively (P = 0.66). There were no differences in false-positive rate (CC entrances detected in CMR and absent in EAM: 7.5% vs 7.8% in WB vs. conventional CMR, P = 0.92) nor in false-negative rate (CC entrances present in EAM not detected in CMR: 14.9% vs.7.8% in WB vs. conventional CMR, P = 0.23). Epicardial CCs was predictor of poor CMR/EAM concordance (OR 2.15, P = 0.031).
Use of WB-LGE-CMR sequence in ICD-patients allows adequate VT substrate characterization to guide VT ablation with similar accuracy than conventional LGE-CMR in patients without an ICD.
室性心动过速（VT）的基于病灶的消融已成为一种标准程序。电解剖标测（EAM）可检测到疤痕组织的异质性，并确定消融靶点的传导通道（CC）。钆延迟增强心脏磁共振（LGE-CMR）能够描绘 CC 并提高消融成功率。大多数接受 VT 消融的患者都有植入式心脏复律除颤器（ICD），这会在 LGE-CMR 中引起图像伪影。最近，宽带（WB）LGE-CMR 序列已被证明可以减少这些伪影。本研究的目的是分析 WB-LGE-CMR 在识别 CC 入口方面的准确性。
纳入了 13 例连续接受 WB-LGE-CMR 后进行 VT 消融的 ICD 患者。比较了三维 EAM 和 WB-LGE-CMR 重建中 CC 入口的数量和位置。通过与心肌病、疤痕位置和年龄匹配的历史队列（26 例患者）进行比较，评估了与 ICD 前 LGE-CMR 的一致性。在 WB-CMR 组中，EAM 和 WB-LGE-CMR 分别识别出 101 和 93 个 CC 入口。在历史队列中，EAM 和 LGE-CMR 均识别出 179 个 CC 入口。WB 和历史组的 EAM/CMR 一致性分别为 85.1%和 92.2%（P=0.66）。假阳性率（CMR 中检测到而 EAM 中未检测到的 CC 入口：WB 与传统 CMR 分别为 7.5%和 7.8%，P=0.92）和假阴性率（EAM 中检测到而 CMR 中未检测到的 CC 入口：WB 与传统 CMR 分别为 14.9%和 7.8%，P=0.23）均无差异。心外膜 CC 是 CMR/EAM 一致性差的预测因素（OR 2.15，P=0.031）。
在 ICD 患者中使用 WB-LGE-CMR 序列可以对 VT 病灶进行充分的特征描述，指导 VT 消融，其准确性与无 ICD 患者的传统 LGE-CMR 相似。
