Hubert Cochet MD, Presenter: Nothing to Disclose

Amir Sherwan Jadidi, Abstract Co-Author: Nothing to Disclose

Olivier Corneloup MD, Abstract Co-Author: Nothing to Disclose

Mathieu Lederlin, Abstract Co-Author: Nothing to Disclose

Jatin Relan, Abstract Co-Author: Nothing to Disclose

Michel Montaudon MD, Abstract Co-Author: Nothing to Disclose

Maxime Sermesant, Abstract Co-Author: Nothing to Disclose

Pierre Jaïs, Abstract Co-Author: Nothing to Disclose

Francois H. Laurent MD, Abstract Co-Author: Nothing to Disclose

To evaluate the correlation between scar as depicted by delayed enhancement (DE) MRI and the electrophysiological arrhythmogenic substrate in scar-related ventricular tachycardia (VT).

10 patients (4 ICM, 3 myocarditis, 2 ARVC, 1 non-ischemic DCM) underwent DE MRI at high spatial resolution (voxel size 0.625x0.625x2.5mm) prior to VT ablation. The endocardium and epicardium were manually segmented. Scar was automatically segmented on myocardial histogram with a threshold set at 3SD above mean signal of remote myocardium. From the segmented images, a digital 3D model was computed and imported in 3D mapping systems. During the mapping/ablation procedure, this model was co-registered in real time to the electrophysiological mapping geometry. Endocardial and epicardial contact mapping was performed at high density (>500 sites per map) during sinus rhythm (SR) and VT. The electrophysiological VT substrate (abnormal/late activity during SR, critical isthmus during VT) was correlated to DE MRI data.

The integration of MRI data enabled a 3D visualization of the endocardium, epicardium and scar during the mapping/ablation procedure. VT was mapped in 7/10 patients. Critical isthmuses located within scar areas in 4 patients (2 myocarditis, 1 ICM, 1 ARVC), and at the border zone (<6mm from scar) in 3 patients (3 ICM). Epicardial isthmuses matched sub-epicardial scar at MRI in all cases (3/3, 2 myocarditis, 1 ARVC). SR was mapped in all patients. The target for ablation in SR (abnormal/late activity) matched myocardial scar at DE MRI in all patients (10/10).

The electrophysiological VT substrate correlates to DE at MRI. The integration of DE MRI data in 3D mapping systems is useful to guide mapping/ablation of scar-related VT.

The integration of DE MRI data in 3D mapping systems is useful to guide mapping/ablation of scar-related VT

Cochet, H, Jadidi, A, Corneloup, O, Lederlin, M, Relan, J, Montaudon, M, Sermesant, M, Jaïs, P, Laurent, F, Myocardial Scar Modeling from Delayed Enhancement MRI: Usefulness for the Guidance of Ventricular Tachycardia Mapping and Ablation.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11009093.html