PMID- 21270103 OWN - NLM STAT- MEDLINE DCOM- 20110617 LR - 20191210 IS - 1941-3084 (Electronic) IS - 1941-3084 (Linking) VI - 4 IP - 2 DP - 2011 Apr TI - MRI-Guided ventricular tachycardia ablation: integration of late gadolinium-enhanced 3D scar in patients with implantable cardioverter-defibrillators. PG - 172-84 LID - 10.1161/CIRCEP.110.958744 [doi] AB - BACKGROUND: Substrate-guided ablation of ventricular tachycardia (VT) in patients with implanted cardioverter-defibrillators (ICDs) relies on voltage mapping to define the scar and border zone. An integrated 3D scar reconstruction from late gadolinium enhancement (LGE) MRI could facilitate VT ablations. METHODS AND RESULTS: Twenty-two patients with ICD underwent contrast-enhanced cardiac MRI with a specific absorption rate of <2.0 W/kg before VT ablation. Device interrogation demonstrated unchanged ICD parameters immediately before, after, or at 68+/-21 days follow-up (P>0.05). ICD imaging artifacts were most prominent in the anterior wall and allowed full and partial assessment of LGE in 9+/-4 and 12+/-3 of 17 segments, respectively. In 14 patients with LGE, a 3D scar model was reconstructed and successfully registered with the clinical mapping system (accuracy, 3.9+/-1.8 mm). Using receiver operating characteristic curves, bipolar and unipolar voltages of 1.49 and 4.46 mV correlated best with endocardial MRI scar. Scar visualization allowed the elimination of falsely low voltage recordings (suboptimal catheter contact) in 4.1+/-1.9% of <1.5-mV mapping points. Display of scar border zone allowed identification of excellent pace mapping sites, with only limited voltage mapping in 64% of patients. Viable endocardium of >2 mm resulted in >1.5-mV voltage recordings despite up to 63% transmural midmyocardial scar successfully ablated with MRI guidance. All successful ablation sites demonstrated LGE (transmurality, 68+/-26%) and were located within 10 mm of transition zones to 0% to 25% scar in 71%. CONCLUSIONS: Contrast-enhanced cardiac MRI can be safely performed in selected patients with ICDs and allows the integration of detailed 3D scar maps into clinical mapping systems, providing supplementary anatomic guidance to facilitate substrate-guided VT ablations. FAU - Dickfeld, Timm AU - Dickfeld T AD - Division of Cardiology, University of Maryland, Baltimore, 21201, USA. tdickfel@medicine.umaryland.edu FAU - Tian, Jing AU - Tian J FAU - Ahmad, Ghada AU - Ahmad G FAU - Jimenez, Alejandro AU - Jimenez A FAU - Turgeman, Aharon AU - Turgeman A FAU - Kuk, Richard AU - Kuk R FAU - Peters, Matthew AU - Peters M FAU - Saliaris, Anastasios AU - Saliaris A FAU - Saba, Magdi AU - Saba M FAU - Shorofsky, Stephen AU - Shorofsky S FAU - Jeudy, Jean AU - Jeudy J LA - eng PT - Evaluation Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110126 PL - United States TA - Circ Arrhythm Electrophysiol JT - Circulation. Arrhythmia and electrophysiology JID - 101474365 RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 15G12L5X8K (gadobenic acid) RN - 6HG8UB2MUY (Meglumine) SB - IM MH - Adult MH - Aged MH - Artifacts MH - Catheter Ablation/*methods MH - Cicatrix/pathology MH - *Contrast Media MH - *Defibrillators, Implantable MH - Electric Countershock/*instrumentation MH - Electrophysiologic Techniques, Cardiac MH - Feasibility Studies MH - Female MH - Humans MH - *Image Interpretation, Computer-Assisted MH - *Imaging, Three-Dimensional MH - *Magnetic Resonance Imaging, Interventional MH - Male MH - Meglumine/*analogs & derivatives MH - Middle Aged MH - *Organometallic Compounds MH - Predictive Value of Tests MH - Surgery, Computer-Assisted/*methods MH - Tachycardia, Ventricular/pathology/physiopathology/*therapy MH - Time Factors MH - Treatment Outcome EDAT- 2011/01/29 06:00 MHDA- 2011/06/18 06:00 CRDT- 2011/01/29 06:00 PHST- 2011/01/29 06:00 [entrez] PHST- 2011/01/29 06:00 [pubmed] PHST- 2011/06/18 06:00 [medline] AID - CIRCEP.110.958744 [pii] AID - 10.1161/CIRCEP.110.958744 [doi] PST - ppublish SO - Circ Arrhythm Electrophysiol. 2011 Apr;4(2):172-84. doi: 10.1161/CIRCEP.110.958744. Epub 2011 Jan 26.