Roca-Luque Ivo, Mont-Girbau Lluis
Arrhythmia Section, Cardiology Department, Cardiovascular Clinical Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Front Cardiovasc Med. 2022 Jan 12;8:797864. doi: 10.3389/fcvm.2021.797864. eCollection 2021.
Ventricular tachycardia is the most frequent cause of sudden cardiovascular death in patients with structural heart disease. Radiofrequency ablation is the treatment cornerstone in this population. Main mechanism for structural heart disease-related ventricular tachycardia is re-entry due to presence of slow conduction area within the scar tissue. Electroanatomical mapping with high density catheters can elucidate the presence of both scar (voltage maps) and slow conduction (activation maps). Despite the technological improvements recurrence rate after ventricular tachycardia ablation is high. Cardiac magnetic resonance has demonstrated to be useful to define the location of the scar tissue in endocardium, midmyocardium and/or epicardial region. Furthermore, recent studies have shown that cardiac magnetic resonance can analyse in detail the ventricular tachycardia substrate in terms of core scar and border zone tissue. This detailed tissue analysis has been proved to have good correlation with slow conduction areas and ventricular tachycardia isthmuses in electroanatomical maps. This review will provide a summary of the current role of cardiac magnetic resonance in different scenarios related with ventricular tachycardia in patients with structural heart disease, its limitations and the future perspectives.
室性心动过速是结构性心脏病患者心血管性猝死的最常见原因。射频消融是这一人群的治疗基石。结构性心脏病相关室性心动过速的主要机制是由于瘢痕组织内存在缓慢传导区域而导致的折返。使用高密度导管进行电解剖标测可以明确瘢痕（电压图）和缓慢传导（激动图）的存在。尽管技术有所进步，但室性心动过速消融术后的复发率仍然很高。心脏磁共振已被证明有助于确定心内膜、心肌中层和/或心外膜区域瘢痕组织的位置。此外，最近的研究表明，心脏磁共振可以从核心瘢痕和边缘区组织方面详细分析室性心动过速基质。这种详细的组织分析已被证明与电解剖图中的缓慢传导区域和室性心动过速峡部具有良好的相关性。本综述将总结心脏磁共振在结构性心脏病患者室性心动过速相关不同情况下的当前作用、其局限性及未来展望。
