High-resolution structural-functional substrate-trigger characterization: Future roadmap for catheter ablation of...

Area of Science:

• Cardiovascular Imaging
• Computational Electrophysiology
• Cardiac Electrophysiology

Background:

• Ventricular tachyarrhythmias (VT) pose a high risk of sudden cardiac death.
• Catheter ablation for VT has limitations, including recurrence and complications.
• Current personalized models often lack detailed 3D electrical information.

Purpose of the Study:

• To hypothesize that incorporating non-invasive 3D electrical and structural characterization in patient-specific models improves VT-substrate recognition and ablation targeting.
• To develop and validate a personalized 3D model integrating structural and electrical data for VT management.

Main Methods:

• Constructed a structural-functional model using 3D late-gadolinium enhancement cardiac magnetic resonance imaging (3D-LGE CMR), computed tomography (CT), and electrocardiographic imaging (ECGI).
• Integrated invasive high-density contact and pace mapping data.
• Analyzed the integrated 3D electro-anatomic model off-line to identify VT substrate and guide ablation.

Main Results:

• Merged invasive voltage maps with 3D-LGE CMR geometry, revealing correlations between low voltage, fibrosis, and conduction abnormalities.
• ECGI identified epicardial VT exit near heterogeneous tissue corridors.
• Radiofrequency ablation guided by the model rendered the patient non-inducible and arrhythmia-free for 20 months.

Conclusions:

• Developed a personalized 3D model integrating high-resolution structural and electrical information.
• The model enhances mechanistic understanding of scar-related VT.
• Provides a non-invasive roadmap for improved catheter ablation targeting in VT patients.