Noninvasive Detection of Slow Conduction with Cardiac Magnetic Resonance Imaging for VT Ablation.

BACKGROUND

Noninvasive myocardial scar characterization with cardiac magnetic resonance (CMR) has been shown to accurately identify conduction channels and can be an important aid for ventricular tachycardia (VT) ablation. A new mapping method based on targeting deceleration zones (DZs) has become one of the most commonly used strategies for VT ablation procedures.

AIMS

To analyze the capability of CMR to identify DZs and to find predictors of arrhythmogenicity in CMR channels.

METHODS

Forty-four consecutive patients with structural heart disease and VT undergoing ablation after CMR at a single center (October 2018 to July 2021) were included (mean age, 64.8±11.6 years; 95.5% male; 70.5% with ischemic heart disease; mean ejection fraction of 32.3±7.8%). Characteristics of CMR channels were analyzed, and correlations with DZs detected during isochronal late activation mapping (ILAM) in both baseline maps and remaps were determined.

RESULTS

Overall, 109 automatically detected CMR channels were analyzed (2.48±1.15 per patient; length, 57.91±63.07 mm; CC mass, 2.06±2.67 grams; protectedness, 21.44±25.39 mm). Overall, 76.1% of CMR channels were associated with a DZ. Univariate analysis showed that channels associated with DZs were longer (67.81±68.45 vs. 26.31±21.25 mm, OR 1.03, p=0.010), with higher border zone mass (2.41±2.91 vs. 0.87±0.86 g, OR 2.46, p=0.011) and greater protectedness (24.97±27.72 vs. 10.19±9.52 mm, OR 1.08, p=0.021).

CONCLUSIONS

Noninvasive detection of targets for VT ablation is possible with CMR. DZs found during EAM accurately correlate with CMR channels, especially those with increased length, border zone mass and protectedness.

Informations de copyright

© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.