Clin Res Cardiol 101, Suppl 1, April 2012

V100 - Ventricular Delayed Enhancement at MRI matches critical isthmus/exit sites of ventricular tachycardia circuits and sites of slow conduction in sinus rhythm - Integrating MR-data for VT Ablation
A. S. Jadidi1, H. Cochet2, F. Sacher3, R. Weber1, J. Schiebeling-Römer1, H. Lehrmann1, J. Allgeier1, C. Herrera Siklódy1, M. Haissaguerre3, P. Jais3, T. Arentz1
1Rhythmologie, Herzzentrum Bad Krozingen, Bad Krozingen; 2Imagerie Cardiaque, Hopital Cardiologique du Haut Leveque, CHU Bordeaux, Pessac Bordeaux, Frankreich; 3Rythmologie, Hopital Cardiologique du haut-Leveque, CHU Bordeaux, Pessac Bordeaux, Frankreich;
Introduction: MRI Delayed Gadolinium enhancement (DE) enables imaging of myocardial scar. We hypothesized that regions of DE correlate to the electrophysiological VT substrate and particularly to the critical isthmus/exit sites of clinical VT circuits, regions of  abnormal or late activation in sinus rhythm (SR) and low voltage. 
Methods: 11 pts (4 ICM, 3 myocarditis, 3 ARVC, 1 DCM) underwent DEMRI prior to VT ablation. Endocardium, epicardium and ventricular scar (DE) were segmented and imported to the 3D mapping system (NavX/Velocity, Carto3). A high density 20- or 30-pole catheter (Pentaray1 or 2) was used to acquire the endo- and epicardial activation in SR and VT (>796 sites per map).  
Results: Registration of MR derived endocardium, epicardium and ventricular scar to patient’s mapping geometry, allowed direct visualization of scar (DE) during VT mapping/ablation. VT was mapped in 8/11 pts. The VT isthmus was located within region of DE in 2 pts with ICM or at borderzones of DE (within 6 mm distance) in 3 pts. In pts with myocarditis, VT isthmuses located to the epicardium, matching epicardial DE at MRI. Abnormal/late activity in SR, that was targeted for ablation, matched regions of scar (DE) at MRI in all pts. Freedom of any VT at 14+/-4months FU is 70%.


Conclusion: The electrophysiological substrate of VT correlates with regions of myocardial late Gadolinium enhancement at MRI. Integration of MR-data on myocardial scar in 3D mapping systems is useful for mapping and ablation of scar-related VT. This implicates MRI-DE imaging in patients prior to ICD implantation.

Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6