PMID- 31219547 OWN - NLM STAT- MEDLINE DCOM- 20201214 LR - 20210110 IS - 1532-2092 (Electronic) IS - 1099-5129 (Print) IS - 1099-5129 (Linking) VI - 21 IP - 9 DP - 2019 Sep 1 TI - Evaluation of a real-time magnetic resonance imaging-guided electrophysiology system for structural and electrophysiological ventricular tachycardia substrate assessment. PG - 1432-1441 LID - 10.1093/europace/euz165 [doi] AB - AIMS: Potential advantages of real-time magnetic resonance imaging (MRI)-guided electrophysiology (MR-EP) include contemporaneous three-dimensional substrate assessment at the time of intervention, improved procedural guidance, and ablation lesion assessment. We evaluated a novel real-time MR-EP system to perform endocardial voltage mapping and assessment of delayed conduction in a porcine ischaemia-reperfusion model. METHODS AND RESULTS: Sites of low voltage and slow conduction identified using the system were registered and compared to regions of late gadolinium enhancement (LGE) on MRI. The Sorensen-Dice similarity coefficient (DSC) between LGE scar maps and voltage maps was computed on a nodal basis. A total of 445 electrograms were recorded in sinus rhythm (range: 30-186) using the MR-EP system including 138 electrograms from LGE regions. Pacing captured at 103 sites; 47 (45.6%) sites had a stimulus-to-QRS (S-QRS) delay of >/=40 ms. Using conventional (0.5-1.5 mV) bipolar voltage thresholds, the sensitivity and specificity of voltage mapping using the MR-EP system to identify MR-derived LGE was 57% and 96%, respectively. Voltage mapping had a better predictive ability in detecting LGE compared to S-QRS measurements using this system (area under curve: 0.907 vs. 0.840). Using an electrical threshold of 1.5 mV to define abnormal myocardium, the total DSC, scar DSC, and normal myocardium DSC between voltage maps and LGE scar maps was 79.0 +/- 6.0%, 35.0 +/- 10.1%, and 90.4 +/- 8.6%, respectively. CONCLUSION: Low-voltage zones and regions of delayed conduction determined using a real-time MR-EP system are moderately associated with LGE areas identified on MRI. CI - (c) The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. FAU - Mukherjee, Rahul K AU - Mukherjee RK AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. FAU - Costa, Caroline Mendonca AU - Costa CM AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. FAU - Neji, Radhouene AU - Neji R AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. AD - Siemens Healthcare, Sir William Siemens Square, Frimley, Camberley, UK. FAU - Harrison, James L AU - Harrison JL AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. AD - Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK. FAU - Sim, Iain AU - Sim I AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. FAU - Williams, Steven E AU - Williams SE AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. AD - Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Whitaker, John AU - Whitaker J AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. FAU - Chubb, Henry AU - Chubb H AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. FAU - O'Neill, Louisa AU - O'Neill L AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. FAU - Schneider, Rainer AU - Schneider R AD - Siemens Healthcare GmbH, Erlangen, Germany. FAU - Lloyd, Tom AU - Lloyd T AD - Imricor Medical Systems, 400 Gateway Blvd, MN, USA. FAU - Pohl, Thomas AU - Pohl T AD - Siemens Healthcare GmbH, Erlangen, Germany. FAU - Roujol, Sebastien AU - Roujol S AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. FAU - Niederer, Steven A AU - Niederer SA AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. FAU - Razavi, Reza AU - Razavi R AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. FAU - O'Neill, Mark D AU - O'Neill MD AD - School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, UK. AD - Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK. LA - eng GR - FS/18/27/33543/BHF_/British Heart Foundation/United Kingdom PT - Journal Article PL - England TA - Europace JT - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology JID - 100883649 SB - IM MH - Animals MH - Cardiac Conduction System Disease/*diagnostic imaging/etiology/*physiopathology/surgery MH - Catheter Ablation MH - Disease Models, Animal MH - Electrophysiologic Techniques, Cardiac/*methods MH - Magnetic Resonance Imaging/methods MH - Magnetic Resonance Imaging, Interventional/*methods MH - Male MH - Myocardial Reperfusion Injury/complications/diagnostic imaging/*physiopathology MH - Surgery, Computer-Assisted MH - Sus scrofa MH - Swine MH - Tachycardia, Ventricular/*diagnostic imaging/etiology/*physiopathology/surgery PMC - PMC6735875 OTO - NOTNLM OT - Electroanatomic mapping OT - Late gadolinium enhancement OT - Magnetic resonance imaging OT - Real time OT - Substrate OT - Ventricular tachycardia EDAT- 2019/06/21 06:00 MHDA- 2020/12/15 06:00 PMCR- 2019/06/20 CRDT- 2019/06/21 06:00 PHST- 2019/01/17 00:00 [received] PHST- 2019/05/22 00:00 [accepted] PHST- 2019/06/21 06:00 [pubmed] PHST- 2020/12/15 06:00 [medline] PHST- 2019/06/21 06:00 [entrez] PHST- 2019/06/20 00:00 [pmc-release] AID - 5521053 [pii] AID - euz165 [pii] AID - 10.1093/europace/euz165 [doi] PST - ppublish SO - Europace. 2019 Sep 1;21(9):1432-1441. doi: 10.1093/europace/euz165.