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Englert F, Bahlke F, Erhard N, Krafft H, Popa MA, Risse E, Lennerz C, Lengauer S, Telishevska M, Reents T, Kottmaier M, Kolb C, Hessling G, Deisenhofer I, Bourier F. VT ablation based on CT imaging substrate visualization: results from a large cohort of ischemic and non-ischemic cardiomyopathy patients. Clin Res Cardiol 2024; 113:1478-1484. [PMID: 38112744 PMCID: PMC11420303 DOI: 10.1007/s00392-023-02321-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/09/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The eradication of ventricular tachycardia (VT) isthmus sites constitutes the minimal procedural endpoint for VT ablation procedures. Contemporary high-resolution computed tomography (CT) imaging, in combination with computer-assisted analysis and segmentation of CT data, facilitates targeted elimination of VT isthmi. In this context, inHEART offers digitally rendered three-dimensional (3D) cardiac models which allow preoperative planning for VT ablations in ischemic and non-ischemic cardiomyopathies. To date, almost no data have been collected to compare the outcomes of VT ablations utilizing inHEART with those of traditional ablation approaches. METHODS The presented data are derived from a retrospective analysis of n = 108 patients, with one cohort undergoing VT ablation aided by late-enhancement CT and subsequent analysis and segmentation by inHEART, while the other cohort received ablation through conventional methods like substrate mapping and activation mapping. The ablations were executed utilizing a 3D mapping system (Carto3), with the mapping generated via the CARTO® PENTARAY™ NAV catheter and subsequently merged with the inHEART model, if available. RESULTS Results showed more successful outcome of ablations for the inHEART group with lower VT recurrence (27% vs. 42%, p < 0.06). Subsequent analyses revealed that patients with ischemic cardiomyopathies appeared to derive a significant benefit from inHEART-assisted VT ablation procedures, with a higher rate of successful ablation (p = 0.05). CONCLUSION Our findings indicate that inHEART-guided ablation is associated with reduced VT recurrence compared to conventional procedures. This suggests that employing advanced imaging and computational modeling in VT ablation may be valuable for VT recurrences.
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Affiliation(s)
- F Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - F Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - N Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - H Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - M-A Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - E Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - C Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - S Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - M Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - T Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - M Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - C Kolb
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - G Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - I Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - F Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany.
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De Silva K, Campbell T, Bennett RG, Anderson RD, Davey C, O'Donohue AK, Schindeler A, Turnbull S, Selvakumar D, Bhaskaran A, Kotake Y, Hsu CJ, Chong JJH, Kizana E, Kumar S. Whole-Heart Histological and Electroanatomic Assessment of Postinfarction Cardiac Magnetic Resonance Imaging Scar and Conducting Channels. Circ Arrhythm Electrophysiol 2024; 17:e012922. [PMID: 39193754 DOI: 10.1161/circep.124.012922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Cardiac magnetic resonance imaging (CMR)-defined ventricular scar and anatomic conduction channels (CMR-CCs) offer promise in delineating ventricular tachycardia substrate. No studies have validated channels with coregistered histology, nor have they ascertained the histological characteristics of deceleration zones (DZs) within these channels. We aimed to validate CMR scar and CMR-CCs with whole-heart histology and electroanatomic mapping in a postinfarction model. METHODS Five sheep underwent anteroseptal infarction. CMR (116±20 days post infarct) was postprocessed using ADAS-3D, varying pixel intensity thresholds (5545, 6040, 6535, and 7030). DZs were identified by electroanatomic mapping (129±12 days post infarct). Explanted hearts were sectioned and stained with Picrosirius red, and whole-heart histopathologic shells were generated. Scar topography as well as percentage fibrosis, adiposity, and remaining viable myocardium within 3 mm histological biopsies and within CMR-CCs were determined. RESULTS Using the standard 6040 thresholding, CMR had 83.8% accuracy for identifying histological scar in the endocardium (κ, 0.666) and 61.4% in the epicardium (κ, 0.276). Thirty-seven CMR-CCs were identified by varying thresholding; 23 (62%) were unique. DZs colocalized to 19 of 23 (83%) CMR-CCs. Twenty (87%) CMR-CCs were histologically confirmed. Within-channel histological fibrosis did not differ by the presence of DZs (P=0.242). Within-channel histological adiposity was significantly higher at sites with versus without DZs (24.1% versus 8.3%; P<0.001). CONCLUSIONS Postprocessed CMR-derived scars and channels were validated by histology and electroanatomic mapping. Regions of CMR-CCs at sites of DZs had higher adiposity but similar fibrosis than regions without DZs, suggesting that lipomatous metaplasia may contribute to arrhythmogenicity of postinfarction scar.
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Affiliation(s)
- Kasun De Silva
- Department of Cardiology, Westmead Hospital, New South Wales, Australia (K.D.S., T.C., R.G.B., S.T., D.S., A.B., Y.K., C.-j.H., J.J.H.C., E.K., S.K.)
- Westmead Applied Research Centre, The University of Sydney, New South Wales, Australia (K.D.S., T.C., R.G.B., C.D., S.T., A.B., Y.K., S.K.)
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, New South Wales, Australia (K.D.S., T.C., R.G.B., S.T., D.S., A.B., Y.K., C.-j.H., J.J.H.C., E.K., S.K.)
- Westmead Applied Research Centre, The University of Sydney, New South Wales, Australia (K.D.S., T.C., R.G.B., C.D., S.T., A.B., Y.K., S.K.)
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, New South Wales, Australia (K.D.S., T.C., R.G.B., S.T., D.S., A.B., Y.K., C.-j.H., J.J.H.C., E.K., S.K.)
- Westmead Applied Research Centre, The University of Sydney, New South Wales, Australia (K.D.S., T.C., R.G.B., C.D., S.T., A.B., Y.K., S.K.)
- Division of Cardiology, University of British Columbia, Vancouver, Canada (R.G.B.)
| | - Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, and Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Victoria, Australia (R.D.A.)
| | - Chris Davey
- Westmead Applied Research Centre, The University of Sydney, New South Wales, Australia (K.D.S., T.C., R.G.B., C.D., S.T., A.B., Y.K., S.K.)
| | - Alexandra K O'Donohue
- Bioengineering and Molecular Medicine Laboratory, The Children's Hospital at Westmead and The Westmead Institute for Medical Research, New South Wales, Australia (A.K.O., A.S.)
- School of Chemical and Biomolecular Engineering, Faculty of Engineering, University of Sydney, New South Wales, Australia (A.K.O., A.S.)
| | - Aaron Schindeler
- Bioengineering and Molecular Medicine Laboratory, The Children's Hospital at Westmead and The Westmead Institute for Medical Research, New South Wales, Australia (A.K.O., A.S.)
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, New South Wales, Australia (K.D.S., T.C., R.G.B., S.T., D.S., A.B., Y.K., C.-j.H., J.J.H.C., E.K., S.K.)
- Westmead Applied Research Centre, The University of Sydney, New South Wales, Australia (K.D.S., T.C., R.G.B., C.D., S.T., A.B., Y.K., S.K.)
| | - Dinesh Selvakumar
- Department of Cardiology, Westmead Hospital, New South Wales, Australia (K.D.S., T.C., R.G.B., S.T., D.S., A.B., Y.K., C.-j.H., J.J.H.C., E.K., S.K.)
- Centre for Heart Research, The Westmead Institute for Medical Research, New South Wales, Australia (D.S., J.J.H.C., E.K.)
| | - Ashwin Bhaskaran
- Department of Cardiology, Westmead Hospital, New South Wales, Australia (K.D.S., T.C., R.G.B., S.T., D.S., A.B., Y.K., C.-j.H., J.J.H.C., E.K., S.K.)
- Westmead Applied Research Centre, The University of Sydney, New South Wales, Australia (K.D.S., T.C., R.G.B., C.D., S.T., A.B., Y.K., S.K.)
| | - Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, New South Wales, Australia (K.D.S., T.C., R.G.B., S.T., D.S., A.B., Y.K., C.-j.H., J.J.H.C., E.K., S.K.)
- Westmead Applied Research Centre, The University of Sydney, New South Wales, Australia (K.D.S., T.C., R.G.B., C.D., S.T., A.B., Y.K., S.K.)
| | - Chi-Jen Hsu
- Department of Cardiology, Westmead Hospital, New South Wales, Australia (K.D.S., T.C., R.G.B., S.T., D.S., A.B., Y.K., C.-j.H., J.J.H.C., E.K., S.K.)
| | - James J H Chong
- Department of Cardiology, Westmead Hospital, New South Wales, Australia (K.D.S., T.C., R.G.B., S.T., D.S., A.B., Y.K., C.-j.H., J.J.H.C., E.K., S.K.)
- Centre for Heart Research, The Westmead Institute for Medical Research, New South Wales, Australia (D.S., J.J.H.C., E.K.)
| | - Eddy Kizana
- Department of Cardiology, Westmead Hospital, New South Wales, Australia (K.D.S., T.C., R.G.B., S.T., D.S., A.B., Y.K., C.-j.H., J.J.H.C., E.K., S.K.)
- Centre for Heart Research, The Westmead Institute for Medical Research, New South Wales, Australia (D.S., J.J.H.C., E.K.)
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, New South Wales, Australia (K.D.S., T.C., R.G.B., S.T., D.S., A.B., Y.K., C.-j.H., J.J.H.C., E.K., S.K.)
- Westmead Applied Research Centre, The University of Sydney, New South Wales, Australia (K.D.S., T.C., R.G.B., C.D., S.T., A.B., Y.K., S.K.)
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Wilhelm TI, Lewalter T, Fischer J, Reiser J, Werner J, Baumgartner C, Gleirscher L, Hoppmann P, Kupatt C, Tiemann K, Jilek C. Electroanatomical Conduction Characteristics of Pig Myocardial Tissue Derived from High-Density Mapping. J Clin Med 2023; 12:5598. [PMID: 37685665 PMCID: PMC10488835 DOI: 10.3390/jcm12175598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Ultra-high-density mapping systems allow more precise measurement of the heart chambers at corresponding conduction velocities (CVs) and voltage amplitudes (VAs). Our aim for this study was to define and compare a basic value set for unipolar CV and VA in all four heart chambers and their separate walls in healthy, juvenile porcine hearts using ultra-high-density mapping. METHODS We used the Rhythmia Mapping System to create electroanatomical maps of four pig hearts in sinus rhythm. CVs and VAs were calculated for chambers and wall segments with overlapping circular areas (radius of 5 mm). RESULTS We analysed 21 maps with a resolution of 1.4 points/mm2. CVs were highest in the left atrium (LA), followed by the left ventricle (LV), right ventricle (RV), and right atrium (RA). As for VA, LV was highest, followed by RV, LA, and RA. The left chambers had a higher overall CV and VA than the right. Within the chambers, CV varied more in the right than in the left chambers, and VA varied in the ventricles but not in the atria. There was a slightly positive correlation between CVs and VAs at velocity values of <1.5 m/s. CONCLUSIONS In healthy porcine hearts, the left chambers showed higher VAs and CVs than the right. CV differs mainly within the right chambers and VA differs only within the ventricles. A slightly positive linear correlation was found between slow CVs and low VAs.
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Affiliation(s)
- Theresa Isabelle Wilhelm
- Peter-Osypka Heart Centre Munich, Internistisches Klinikum München Süd, 81379 Munich, Germany (T.L.)
- Medical Graduate Center, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Thorsten Lewalter
- Peter-Osypka Heart Centre Munich, Internistisches Klinikum München Süd, 81379 Munich, Germany (T.L.)
| | - Johannes Fischer
- Center for Preclinical Research, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Judith Reiser
- Center for Preclinical Research, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Julia Werner
- Center for Preclinical Research, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Christine Baumgartner
- Center for Preclinical Research, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Lukas Gleirscher
- Peter-Osypka Heart Centre Munich, Internistisches Klinikum München Süd, 81379 Munich, Germany (T.L.)
| | - Petra Hoppmann
- Department of Internal Medicine I, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Christian Kupatt
- Department of Internal Medicine I, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Klaus Tiemann
- Peter-Osypka Heart Centre Munich, Internistisches Klinikum München Süd, 81379 Munich, Germany (T.L.)
- Department of Internal Medicine I, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Clemens Jilek
- Peter-Osypka Heart Centre Munich, Internistisches Klinikum München Süd, 81379 Munich, Germany (T.L.)
- Department of Internal Medicine I, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
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Nairn D, Eichenlaub M, Müller-Edenborn B, Huang T, Lehrmann H, Nagel C, Azzolin L, Luongo G, Figueras Ventura RM, Rubio Forcada B, Vallès Colomer A, Westermann D, Arentz T, Dössel O, Loewe A, Jadidi A. Differences in atrial substrate localization using late gadolinium enhancement-magnetic resonance imaging, electrogram voltage, and conduction velocity: a cohort study using a consistent anatomical reference frame in patients with persistent atrial fibrillation. Europace 2023; 25:euad278. [PMID: 37713626 PMCID: PMC10533207 DOI: 10.1093/europace/euad278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/10/2023] [Indexed: 09/17/2023] Open
Abstract
AIMS Electro-anatomical voltage, conduction velocity (CV) mapping, and late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) have been correlated with atrial cardiomyopathy (ACM). However, the comparability between these modalities remains unclear. This study aims to (i) compare pathological substrate extent and location between current modalities, (ii) establish spatial histograms in a cohort, (iii) develop a new estimated optimized image intensity threshold (EOIIT) for LGE-MRI identifying patients with ACM, (iv) predict rhythm outcome after pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF). METHODS AND RESULTS Thirty-six ablation-naive persistent AF patients underwent LGE-MRI and high-definition electro-anatomical mapping in sinus rhythm. Late gadolinium enhancement areas were classified using the UTAH, image intensity ratio (IIR >1.20), and new EOIIT method for comparison to low-voltage substrate (LVS) and slow conduction areas <0.2 m/s. Receiver operating characteristic analysis was used to determine LGE thresholds optimally matching LVS. Atrial cardiomyopathy was defined as LVS extent ≥5% of the left atrium (LA) surface at <0.5 mV. The degree and distribution of detected pathological substrate (percentage of individual LA surface are) varied significantly (P < 0.001) across the mapping modalities: 10% (interquartile range 0-14%) of the LA displayed LVS <0.5 mV vs. 7% (0-12%) slow conduction areas <0.2 m/s vs. 15% (8-23%) LGE with the UTAH method vs. 13% (2-23%) using IIR >1.20, with most discrepancies on the posterior LA. Optimized image intensity thresholds and each patient's mean blood pool intensity correlated linearly (R2 = 0.89, P < 0.001). Concordance between LGE-MRI-based and LVS-based ACM diagnosis improved with the novel EOIIT applied at the anterior LA [83% sensitivity, 79% specificity, area under the curve (AUC): 0.89] in comparison to the UTAH method (67% sensitivity, 75% specificity, AUC: 0.81) and IIR >1.20 (75% sensitivity, 62% specificity, AUC: 0.67). CONCLUSION Discordances in detected pathological substrate exist between LVS, CV, and LGE-MRI in the LA, irrespective of the LGE detection method. The new EOIIT method improves concordance of LGE-MRI-based ACM diagnosis with LVS in ablation-naive AF patients but discrepancy remains particularly on the posterior wall. All methods may enable the prediction of rhythm outcomes after PVI in patients with persistent AF.
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Affiliation(s)
- Deborah Nairn
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, Karlsruhe 76131, Germany
| | - Martin Eichenlaub
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Björn Müller-Edenborn
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Taiyuan Huang
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claudia Nagel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, Karlsruhe 76131, Germany
| | - Luca Azzolin
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, Karlsruhe 76131, Germany
| | - Giorgio Luongo
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, Karlsruhe 76131, Germany
| | | | | | | | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Olaf Dössel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, Karlsruhe 76131, Germany
| | - Axel Loewe
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, Karlsruhe 76131, Germany
| | - Amir Jadidi
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Arrhythmia Division, Department of Cardiology, Heart Center Lucerne, Lucerne Cantonal Hospital, Lucerne, Switzerland
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