针对浸润性肥胖心脏的室性心动过速消融的个性化数字心脏技术。
Personalized Digital-Heart Technology for Ventricular Tachycardia Ablation Targeting in Hearts With Infiltrating Adiposity.
机构信息
Department of Biomedical Engineering (E.S., A.P., S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.
Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD.
出版信息
Circ Arrhythm Electrophysiol. 2020 Dec;13(12):e008912. doi: 10.1161/CIRCEP.120.008912. Epub 2020 Nov 16.
BACKGROUND
Infiltrating adipose tissue (inFAT) is a newly recognized proarrhythmic substrate for postinfarct ventricular tachycardias (VT) identifiable on contrast-enhanced computed tomography. This study presents novel digital-heart technology that incorporates inFAT from contrast-enhanced computed tomography to noninvasively predict VT ablation targets and assesses the capability of the technology by comparing its predictions with VT ablation procedure data from patients with ischemic cardiomyopathy.
METHODS
Digital-heart models reflecting patient-specific inFAT distributions were reconstructed from contrast-enhanced computed tomography. The digital-heart identification of fat-based ablation targeting (DIFAT) technology evaluated the rapid-pacing-induced VTs in each personalized inFAT-based substrate. DIFAT targets that render the inFAT substrate noninducible to VT, including VTs that arise postablation, were determined. DIFAT predictions were compared with corresponding clinical ablations to assess the capabilities of the technology.
RESULTS
DIFAT was developed and applied retrospectively to 29 ischemic cardiomyopathy patients with contrast-enhanced computed tomography. DIFAT ablation volumes were significantly less than the estimated clinical ablation volumes (1.87±0.35 versus 7.05±0.88 cm, <0.0005). DIFAT targets overlapped with clinical ablations in 79% of patients, mostly in the apex (72%) and inferior/inferolateral (74%). In 3 patients, DIFAT targets colocalized with redo ablations delivered years after the index procedure.
CONCLUSIONS
DIFAT is a novel digital-heart technology for individualized VT ablation guidance designed to eliminate VT inducibility following initial ablation. DIFAT predictions colocalized well with clinical ablation locations but provided significantly smaller lesions. DIFAT also predicted VTs targeted in redo procedures years later. As DIFAT uses widely accessible computed tomography, its integration into clinical workflows may augment therapeutic precision and reduce redo procedures.
背景
浸润性脂肪组织（inFAT）是新近发现的梗死区室性心动过速（VT）的促心律失常性底物，可在对比增强计算机断层扫描中识别。本研究提出了一种新的数字心脏技术，该技术将对比增强计算机断层扫描中的 inFAT 纳入其中，以无创性预测 VT 消融靶点，并通过比较其预测与缺血性心肌病患者的 VT 消融程序数据来评估该技术的能力。
方法
从对比增强计算机断层扫描中重建反映患者特定 inFAT 分布的数字心脏模型。数字心脏基于脂肪的消融靶点识别（DIFAT）技术评估了基于个体化 inFAT 基质的快速起搏诱导 VT。确定了使 inFAT 基质对 VT 无诱导性的 DIFAT 靶点，包括消融后出现的 VT。将 DIFAT 预测与相应的临床消融进行比较，以评估该技术的能力。
结果
DIFAT 已开发并应用于 29 例接受对比增强计算机断层扫描的缺血性心肌病患者。DIFAT 消融体积明显小于估计的临床消融体积（1.87±0.35 与 7.05±0.88cm，<0.0005）。DIFAT 靶点与 79%的患者的临床消融靶点重叠，主要位于心尖部（72%）和下/下外侧（74%）。在 3 例患者中，DIFAT 靶点与索引手术后数年内进行的再次消融部位重合。
结论
DIFAT 是一种新的数字心脏技术，用于个体化 VT 消融指导，旨在消除初始消融后 VT 的可诱导性。DIFAT 预测与临床消融部位很好地重叠，但提供的病变较小。DIFAT 还预测了数年后再次进行的消融程序中靶向的 VT。由于 DIFAT 使用广泛获得的计算机断层扫描，其与临床工作流程的整合可能会提高治疗精度并减少再次手术。
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