Caterina Colantoni, Presenter: Nothing to Disclose

Antonio Esposito MD, Abstract Co-Author: Nothing to Disclose

Anna Palmisano MD, Abstract Co-Author: Nothing to Disclose

Sofia Auntunes, Abstract Co-Author: Nothing to Disclose

Francesco Aldo De Cobelli MD, Abstract Co-Author: Nothing to Disclose

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

Most of recurrent VT recognizes a myocardial scar substrate; an ICD-compatible imaging able to assess cardiac scars and anatomy may help to plan and guide EAM and VT ablation. Our purpose was to evaluate the feasibility and usefulness of integrating MDCT data with EAMs for VT substrate assessment and guidance of VT mapping and ablation.

20 patients suffering from recurrent episodes of VT underwent MDCT before VT ablation, including an angiographic-scan and a low-energy (80kV) delayed-scan (10 minutes after high concentration contrast media). For each patient, a 3D-model of the heart (CT-3D-MODEL), representing the cardiac cavities, aortic root, left ventricular wall and myocardial scar in different colours, was obtained by the fusion of angiographic and delayed scan, separately segmented. The CT-3D-MODELs were uploaded on CARTO® system and co-registered with high-density bipolar maps using CARTO-merge. A point-by-point correlation was performed between low-voltage areas at bipolar EAM (≤1.5mV, corresponding to scar) and scars on CT-3D-MODEL, using a homemade software. 20 mm was considered the cut-off for registration-error.

The analysis included 24 scars, counting 15 scars in ischemic cardiomyopathy, 7 scar in non-ischemic cardiomyopathy, and 2 scar of myocardial origin. The bipolar EAMs were mapped with an overall number of 18095 points (min 71; max 2601); 11737 out of 18095 points at EAMs corresponded to scar areas on CT-3D-MODEL with 68% of overall correspondence. Analysis for patient showed a range of correlation between CT-3D-MODEL and EAM varying from 0% to 99%. A correlation between CT-3D-MODEL and EAM > 75% was found in 15 out of 20 patients, in 3 patients the correlation resulted between 50% and 75% and in 2 was < 50%. In these 2 patients the poor correlation was linked to the absence of low voltages at EAM, in one patient, and to the low quality of delayed MDCT scan, in the second case.

Cardiac MDCT with delayed scan allows an accurate assessment of scar substrate of VT in most of patient. The optimized protocol of acquisition and post-processing set-up in this study allows to obtain high resolution CT-3D-MODELs suitable for integration with EAMs on CARTO.

The integration of CT-3D-MODELS with EAM could be useful for identification of VT substrate, potentially improving VT ablation success.

Colantoni, C, Esposito, A, Palmisano, A, Auntunes, S, De Cobelli, F, Del Maschio, A, Merged Multidetector-Computed Tomography (MDCT) with Late-Enhancement and Electroanatomic Mapping (EAM) in Patients Affected by Recurrent Episodes of Ventricular Tachycardia (VT): A Point-by-Point Correlation.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014121.html