Integration of Merged Delayed-Enhanced Magnetic Resonance Imaging and Multi-Detector Computed Tomography for the Guidance of Ventricular Tachycardia Ablation: A Pilot Study

Hubert Cochet (1) , Y. Komatsu (1) , F. Sacher (1) , A. Jadidi (1) , D. Scherr (1) , M. Riffaud (2) , N. Derval (1) , A. Shah (1) , L. Roten (1) , P. Pascale (1) , Jatin Relan (3) , Maxime Sermesant (3) , Nicholas Ayache (3) , M. Montaudon (1) , F. Laurent (1) , M. Hocini (1) , M. Haïssaguerre (1) , Pierre Jaïs (1)

1 CRCTB - Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux]
2 Département de cardiologie
3 ASCLEPIOS - Analysis and Simulation of Biomedical Images

MDCT/MRI Fusion for the Guidance of VT Ablation. Background: Delayed enhancement (DE) MRI can assess the fibrotic substrate of scar-related VT. MDCT has the advantage of inframillimetric spatial resolution and better 3D reconstructions. We sought to evaluate the feasibility and usefulness of integrating merged MDCT/MRI data in 3D-mapping systems for structure–function assessment and multimodal guidance of VT mapping and ablation. Methods: Nine patients, including 3 ischemic cardiomyopathy (ICM), 3 nonischemic cardiomyopathy (NICM), 2 myocarditis, and 1 redo procedure for idiopathic VT, underwent MRI and MDCT before VT ablation. Merged MRI/MDCT data were integrated in 3D-mapping systems and registered to high-density endocardial and epicardial maps. Low-voltage areas (<1.5 mV) and local abnormal ventricular activities (LAVA) during sinus rhythm were correlated to DE at MRI, and wall-thinning (WT) at MDCT. Results: Endocardium and epicardium were mapped with 391 ± 388 and 1098 ± 734 points per map, respectively. Registration of MDCT allowed visualization of coronary arteries during epicardial mapping/ablation. In the idiopathic patient, integration of MRI data identified previously ablated regions. In ICM patients, both DE at MRI and WT at MDCT matched areas of low voltage (overlap 94 ± 6% and 79 ± 5%, respectively). In NICM patients, wall-thinning areas matched areas of low voltage (overlap 63 ± 21%). In patients with myocarditis, subepicardial DE matched areas of epicardial low voltage (overlap 92 ± 12%). A total number of 266 LAVA sites were found in 7/9 patients. All LAVA sites were associated to structural substrate at imaging (90% inside, 100% within 18 mm). Conclusion: The integration of merged MDCT and DEMRI data is feasible and allows combining substrate assessment with high-spatial resolution to better define structure–function relationship in scar-related VT.

Domaines: Imagerie médicale; Traitement des images [eess.IV]; Traitement du signal et de l'image [eess.SP]; Traitement du signal et de l'image [eess.SP]; Modélisation et simulation

Hubert Cochet, Y. Komatsu, F. Sacher, A. Jadidi, D. Scherr, et al.. Integration of Merged Delayed-Enhanced Magnetic Resonance Imaging and Multi-Detector Computed Tomography for the Guidance of Ventricular Tachycardia Ablation: A Pilot Study. Journal of Cardiovascular Electrophysiology, 2013, 24 (4), pp.419-426. ⟨10.1111/jce.12052⟩. ⟨hal-00813820⟩