Berruezo Antonio, Penela Diego, Jáuregui Beatriz, Soto-Iglesias David
Heart Institute, Teknon Medical Center, Barcelona, Spain.
Pacing Clin Electrophysiol. 2021 Jun;44(6):1115-1125. doi: 10.1111/pace.14183. Epub 2021 Feb 9.
Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) and multidetector cardiac computed tomography (MDCT) have emerged as novel, fascinating imaging tools for arrhythmogenic substrate identification and characterization. The role of these techniques for aiding and guiding the catheter ablation of ventricular tachycardia, either as a complement or a surrogate of the electroanatomic map, has been rising in recent years. Integrating pixel signal intensity maps or wall thickness maps delivered from LGE-CMR or MDCT, respectively, into the navigation system has become a cornerstone for VT ablation procedures in a few centers of excellence around the world. The pre-procedure scar characterization offers some advantages, helping decide for the best procedure planning and approach; complete substrate identification and characterization, helping to focus electroanatomical mapping in regions of interest and also has a positive impact in procedure efficiency and outcomes. In the present article, we perform a review of the most practical aspects for using LGE-CMR or MDCT when a VT ablation procedure is planned, from the image acquisition to the integration into the navigation system, analyzing the current role of the LGE-CMR and MDCT for arrhythmogenic substrate characterization as well as for guiding VT ablation.
延迟钆增强心脏磁共振成像（LGE-CMR）和多排心脏计算机断层扫描（MDCT）已成为用于识别和表征致心律失常基质的新型、引人入胜的成像工具。近年来，这些技术作为电解剖图的补充或替代手段，在辅助和指导室性心动过速导管消融方面的作用日益凸显。将分别由LGE-CMR或MDCT提供的像素信号强度图或壁厚度图整合到导航系统中，已成为全球一些卓越中心室性心动过速消融手术的基石。术前瘢痕特征分析具有一些优势，有助于确定最佳的手术规划和方法；完整的基质识别和表征有助于将电解剖标测聚焦于感兴趣区域，也对手术效率和结果产生积极影响。在本文中，我们对计划进行室性心动过速消融手术时使用LGE-CMR和MDCT的最实用方面进行综述，从图像采集到整合到导航系统，分析LGE-CMR和MDCT在致心律失常基质表征以及指导室性心动过速消融方面的当前作用。
