Real-time image integration during cardiac ablation for post infarction ventricular tachycardia: impact on clinical outcome

Congress:

ESCR 2014

Poster Number:

409

Type:

Scientific Poster

Keywords:

Cardiac, CT, MR, Ablation procedures, Outcomes

Authors:

M. Salel¹, H. Cochet², F. Laurent², M. Montaudon², O. Corneloup², V. Latrabe², A.-A. Tassadit³, H. Nivet³, G. Chevreau³; ¹Vigoulet-Auzil/FR, ²Pessac/FR, ³Bordeaux/FR

DOI:

DOI-Link:

https://dx.doi.org/

Fig. 1: Figure 1. VT ablation procedures with (left panel) and without (right panel)...

Table 1: Table 1. Baseline characteristics

Table 2: Table 2. Procedural characteristics

Table 3: Table 3. Prediction of VT recurrence - univariable analysis

Purpose

Catheter ablation is an effective therapeutic option in patients presenting with post-infarction ventricular tachycardia (VT)1. The electrophysiological substrate of VT can be assessed with the use of electroanatomical contact mapping. Surviving myocyte bundles within scar can be identified as local abnormal ventricular activities (LAVA) during sinus rhythm, and complete elimination of LAVA by ablation improves patient outcome2. On the other hand, the feasibility of integrating imaging information during VT mapping and ablation has beendemonstrated3, andthe structural substrate defined on imaging was shown to correlate withthe...

Methods and Materials

Population Fifty-eight consecutive patients with sustainedpost-infarction ventricular tachycardia were included(54 men, 63±11 years). Real-time image integration had beenused in the 26 most recentpatients (Group A), but not in the previous32 patients (Group B). Imaging All patients from group A underwent cardiac imaging with either MDCT(N=15), MRI (N=3), or both (N=8). When usingMDCT, myocardial structural substrate was defined on contrast-enhanced first pass images as either wall thinning <5mm, or myocardial hypodensity <0HU. When using MRI, myocardial structural substrate was defined on inversion-recovery prepared and respiratory navigated...

Results

Patientcharacteristics at baseline Baseline characteristics are shown in Table 1. No significant difference was observed between the group with and the one without image integration. Procedural characteristics Procedural characteristics are shown in Table 2. LAVAwere observed in 53/58(91%) patients on endocardium and 22/31(71%) on epicardium. Clinical VT was inducible in 33(57%) patients. Complete LAVA elimination was achieved in 38/58(66%) patients. Clinical/non-clinical VT was inducible after the procedure in 0(0%)/7(12%) patients. No difference was found in complete LAVA elimination rate and loss of inducibility (procedural endpoints)...

Conclusion

Real-time image integration may improve the clinical outcome after catheter ablation in patients with post-infarction VT. Prospective randomized studies are required to confirm these retrospective results.

References

0 false 21 18 pt 18 pt 0 0 false false false Stevenson WG, Wilber DJ, Natale A, et al. Irrigated radiofrequency catheter ablation guided by electroanatomicmapping for recurrent ventricular tachycardia after myocardial infarction: Themulticenter thermocool ventricular tachycardia ablation trial. Circulation 2008;118:2773-2782 Jaïs P, Maury P, Khairy P, et al. Elimination of local abnormal ventricular activities: a new end point for substrate modification in patients with scar-related ventricular tachycardia. Circulation. 2012 May 8;125(18):2184-96. Reddy VY, Malchano ZJ, Holmvang G et al. Integration of cardiac magnetic...