Feasibility study shows concordance between image-based virtual-heart ablation targets and predicted ECG-based...

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Ventricular tachycardia (VT) ablation guidance currently lacks noninvasive methods for precise targeting.
• Two novel noninvasive technologies, PAVEL (population-derived automated VT exit localization) and VAAT (virtual-heart arrhythmia ablation targeting), were developed.

Purpose of the Study:

• To test the hypothesis that image-based VAAT and ECG-based PAVEL technologies are spatially concordant in predicting VT ablation targets.
• To evaluate the feasibility of combining these complementary technologies for noninvasive VT ablation guidance.

Main Methods:

• Retrospective feasibility study in four post-infarct patients undergoing LV VT ablation.
• Patient-specific virtual hearts created using LGE-CMR to identify scar and border zones.
• PAVEL localized VT exit sites on the LV endocardial surface; VAAT identified ablation targets.

Main Results:

• PAVEL localized 9 out of 10 VT exit sites within the scar border zone, correlating with successful ablation lesions.
• VAAT-identified ablation lesions were clinically successful and correlated well with PAVEL-predicted VT exit sites.
• The average distance between PAVEL-predicted exit sites and VAAT lesions was 10.7 ± 7.3 mm.

Conclusions:

• VAAT targets demonstrate spatial concordance with PAVEL-predicted VT exit sites.
• Combining PAVEL and VAAT offers a promising noninvasive approach for targeting clinically induced VTs and potential VT-harboring regions.