Thibault Bernard, Richer Louis-Philippe, McSpadden Luke C, Ryu Kyungmoo, Aguilar Martin, Cadrin-Tourigny Julia, Tadros Rafik, Mondésert Blandine, Rivard Léna, Dyrda Katia, Dubuc Marc, Macle Laurent, Talajic Mario, Khairy Paul, Guerra Peter G, Roy Denis, Grégoire Jean, Harel François
Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Abbott, Sylmar, California.
Heart Rhythm O2. 2022 Jun 27;3(5):560-567. doi: 10.1016/j.hroo.2022.06.008. eCollection 2022 Oct.
The identification of low-voltage proarrhythmic areas for catheter ablation of scar-mediated ventricular tachycardia (VT) remains challenging. Integration of myocardial perfusion imaging (single-photon emission computed tomography/computed tomography; SPECT/CT) and electroanatomical mapping (EAM) may improve delineation of the arrhythmogenic substrate.
To assess the feasibility of SPECT/CT image integration with voltage maps using the EnSite Precision system (Abbott) in patients undergoing scar-mediated VT ablation.
Patients underwent SPECT/CT imaging prior to left ventricular (LV) EAM with the EnSite Precision mapping system. The SPECT/CT, EAM data, and ablation lesions were retrospectively co-registered in the EnSite Precision system and exported for analysis. Segmental tissue viability scores were calculated based on SPECT/CT perfusion and electrogram bipolar voltage amplitude. Concordance, specificity, and sensitivity between the 2 modalities as well as the impact of SPECT/CT spatial resolution were evaluated.
Twenty subjects (95% male, 67 ± 7 years old, left ventricular ejection fraction 36% ± 11%) underwent EAM and SPECT/CT integration. A concordance of 70% was found between EAM and SPECT/CT for identification of cardiac segments as scar vs viable, with EAM showing a 68.5% sensitivity and 76.4% specificity when using SPECT/CT as a gold standard. Projection on low-resolution 3D geometries led to an average decrease of 38% ± 22% of the voltage points used.
The study demonstrated the feasibility of integrating SPECT/CT with EAM performed retrospectively for characterization of anatomical substrates during VT ablation procedures.
识别用于导管消融瘢痕介导的室性心动过速（VT）的低电压致心律失常区域仍然具有挑战性。心肌灌注成像（单光子发射计算机断层扫描/计算机断层扫描；SPECT/CT）与电解剖标测（EAM）的整合可能会改善致心律失常基质的描绘。
评估在接受瘢痕介导的VT消融的患者中，使用EnSite Precision系统（雅培公司）将SPECT/CT图像与电压图整合的可行性。
患者在使用EnSite Precision标测系统进行左心室（LV）EAM之前接受SPECT/CT成像。SPECT/CT、EAM数据和消融灶在EnSite Precision系统中进行回顾性联合配准，并导出进行分析。基于SPECT/CT灌注和电图双极电压幅度计算节段性组织存活分数。评估两种模式之间的一致性、特异性和敏感性以及SPECT/CT空间分辨率的影响。
20名受试者（95%为男性，67±7岁，左心室射血分数36%±11%）接受了EAM和SPECT/CT整合。在将心脏节段识别为瘢痕或存活组织方面，EAM与SPECT/CT之间的一致性为70%，以SPECT/CT作为金标准时，EAM的敏感性为68.5%，特异性为76.4%。投影到低分辨率3D几何图形上导致使用的电压点平均减少38%±22%。
该研究证明了在VT消融手术过程中，回顾性地将SPECT/CT与EAM整合以表征解剖基质的可行性。
