Comparison of combined anatomic and functional modeling with purely anatomic assessment in scar-dependent ventricular
Michael C Waight1, Adityo Prakosa2, Anthony C Li3
1City St George's, University of London, Cranmer Terrace, London, United Kingdom; Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland.
Background:
Cardiac magnetic resonance imaging (MRI) aids the identification of the critical substrate in scar-dependent ventricular tachycardia (VT). Anatomic assessment (AA) of MRI images detects channels that may sustain VT and are viable targets for ablation. Heart digital twins (DTs) combine anatomic data with functional assessment to identify the VT isthmus.
Objective:
This study aimed to assess the additional benefit of combining functional data with anatomy using a DT compared with purely AA in identifying the critical substrate in VT.
Methods:
18 patients with scar-dependent VT planned for catheter ablation underwent contrast-enhanced cardiac MRI. AA to derive conducting channels was performed. Simultaneously, heart DT models combining personalized heart geometry and functional properties were generated and tested for VT inducibility, and optimum ablation lesion sites were predicted. Patients underwent invasive VT ablation. Detection of scar and critical substrate was compared between AA and DT.
Results:
Scar identification was similar between AA and DT. The total area predicted for ablation was similar between AA and DT (9.94 cm2 [±9.46 cm2] vs 9.84 cm2 [±3.23 cm2]; P = .96). The sensitivity for detection of abnormal electrograms was greater with DT than AA (51.4% [±17.6%] vs 25.3% [±25.4%]; P = .002). The sensitivity of detection of deceleration zones, mid-diastolic potentials, and sites of VT termination with ablation was higher with DT than AA, with DT correctly identifying 13 of 16 mid-diastolic potentials (81.3%) compared with 8 of 16 by AA (50.0%).
Conclusion:
The addition of functional data improves detection of the critical substrate above purely AA in scar-dependent VT. DTs are a potentially useful aid in VT ablation.
