3D delayed-enhanced magnetic resonance sequences improve conducting channel delineation prior to ventricular tachycardia ablation

Andreu, David; Ortiz-Pérez, Josè T.; Fernández-Armenta, Juan; Guiu, Esther; Acosta, Juan; Prat‐González, Susanna; Caralt, Teresa M. de; Perea, Rosario J.; Garrido, César; Mont, Lluı́s; Brugada, Josép; Berruezo, Antonio

doi:10.1093/europace/euu310

Cited by 117 publications

(125 citation statements)

References 22 publications

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“…All LGE-CMR images were analysed using a previously described technique 13. Briefly, full LV volume was reconstructed in the axial orientation and the resulting images were processed with ADAS-VT software (Galgo Medical, Barcelona, Spain).…”

Section: Methodsmentioning

confidence: 99%

Influence of myocardial scar on the response to frequent premature ventricular complex ablation

Penela

Martinez

Fernández-Armenta

et al. 2018

Heart

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ObjectiveThis study aims to evaluate the influence of myocardial scar after premature ventricular complexes (PVC) ablation in patients with left ventricular (LV) dysfunction.Methods70 consecutive patients (58±11 years, 58 (83%) men, 23% (18–32) mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation were included. A late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) was performed prior to the ablation and a quantitative and qualitative analysis of the scar was done.ResultsLeft ventricular ejection fraction progressively improved from 34.3%±9% at baseline to 44.4%±12% at 12 months (p<0.01) and 48 (69%) patients were echocardiographic responders. New York Heart Association class improved from 1.96±0.9 points at baseline to 1.36±0.6 at 12 months (p<0.001). Brain natriuretic peptide decreased from 120 (60–284) to 46 (23–81) pg/mL (p=0.04). Twenty-nine (41%) patients showed scar in the preprocedural LGE-CMR with a mean scar mass of 10.4 (5–20) g. Mean scar mass was significantly smaller in responders than in non-responders (0 (0–4.7) g vs 2 (0–14) g, respectively, p=0.017). PVC burden reduction (OR 1.09 (1.01–1.16), p=0.02) and scar mass (OR 0.9 (0.81–0.99), p=0.04) were independent predictors of response, but the former showed a higher accuracy.ConclusionsPresence of myocardial scar modulates, but does not preclude, the probability of response to PVC ablation in patients with LV dysfunction.

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Section: Methodsmentioning

confidence: 99%

Influence of myocardial scar on the response to frequent premature ventricular complex ablation

Penela

Martinez

Fernández-Armenta

et al. 2018

Heart

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“…35, 36 Other recent studies have used segmented myocardial shells to delineate layers of core as distinct from border zones and thereby locate border zone channels that correlate with VT isthmuses identified by electroanatomic pacemapping. 37, 38 …”

Section: Cmr Assessment Of Myocardial Scar and Scar Heterogeneitymentioning

confidence: 99%

Sudden Cardiac Death Substrate Imaged by Magnetic Resonance Imaging

2017

Circ: Cardiovascular Imaging

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Sudden cardiac death (SCD) is a devastating event afflicting 350,000 Americans annually, despite the availability of life-saving preventive therapy, the implantable cardioverter defibrillator (ICD). SCD prevention strategies are hampered by overreliance on global left ventricular ejection fraction (LVEF) below 35% as the most important criterion to determine ICD candidacy. Annually in the U.S. alone, this results in approximately 130,000 ICD placements at a cost of over $3 billion but only a 5% incidence per year of appropriate firings. This approach further fails to identify individuals who experience the majority, as many as 80%, of SCD events, which occur in the setting of more preserved LVEF. Better risk stratification is needed to improve care and should be guided by direct pathophysiologic markers of arrhythmic substrate, such as specific LV structural abnormalities. There is an increasing body of literature to support the prognostic value of cardiac magnetic resonance imaging with late gadolinium enhancement (CMR-LGE) in phenotyping the LV to identify those at highest risk for SCD. CMR has unparalleled tissue characterization ability and provides exquisite detail about myocardial structure and composition, abnormalities of which form the direct, pathophysiologic substrate for SCD. Here we review the evolution and current state of CMR for imaging the arrhythmic substrate, both as a research tool and for clinical applications.

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“…Multiple important studies have been reported within the last 12 months documenting the importance and increased utilization of VT ablation. Despite several remarkable technical and technological improvements and innovations such as use of image integration, 26 novel ablation electrodes, 27,28 forcesensing technologies, 29 or ultra-high density mapping, 30 the relatively high recurrence rate of any VT after catheter ablation in patients with VT and structural heart disease remains a key challenge. As evident from recent multi-centre data, non-inducibility of any VT at the end of the ablation is probably the best endpoint for the procedure and should be targeted.…”

Section: Ventricular Arrhythmias and Sudden Cardiac Deathmentioning

confidence: 99%

The year in cardiology 2015: arrhythmias and device therapy.

2016

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nor in 2015. Rotor ablation using contact phase mapping has been questioned, 10 and CAFÉ ablation is not specific enough to be convincing as demonstrated by a large meta-analysis. 11 In contrast, lifestyle modification such as weight loss is remarkably effective in reducing AF burden (10% loss translates into a sixfold AF burden reduction) and in inducing reverse remodelling on left atrial size and left ventricular septal thickness. 12 Stroke preventionDue to the results from large-scale clinical trials, the nonvitamin K antagonist oral anticoagulants (NOACs) are the preferred treatment for stroke prevention in non-valvular AF, as reflected in current ESC guidelines. 13 As the fourth NOAC, edoxaban has been approved in 2015 in many countries including the USA, Switzerland, and Europe based on the results of the ENGAGE AF-TIMI 48 trial.14 During the year 2015, several subgroup analyses of the large NOAC trials have surfaced, including bleeding management and outcome with apixaban, 15 the management of rivaroxaban around catheter ablation for AF (VENTURE-AF), 16 and the outcome of amiodarone co-medication in patients receiving edoxaban, 17 to name just a few. Virtually, all subgroups of the large NOAC trials indicate a consistent benefit and safety of these drugs compared with warfarin, further underlining their overall superiority. This is supported by important realworld data (including those from a prospective registry with rivaroxaban, XANTUS) 18 indicating efficacy and safety, which is in line with that observed in the randomized clinical trials.Arguably, the most exciting novelty in the field of NOACs comes from the development of specific reversal agents ('antidotes'). In a Phase 1 study in healthy men, the monoclonal antibody idarucizumab (specific for dabigatran) was well tolerated with no unexpected or clinically relevant safety concerns, and was associated with immediate, complete, and sustained reversal of dabigatran-induced anticoagulation. 19 Moreover, in a Phase 3 study, idarucizumab was demonstrated to effectively and immediately reverse the anticoagulant effect of dabigatran in patients presenting with serious bleeding or requiring an urgent procedure. 20 As a result, the US Food and Drug Administration has approved the drug in October 2015; the Committee for Medicinal Products for Human Use of the European Medicines Agency has also recently issued a positive opinion, and approval is expected by the end of this year or early 2016. Importantly, idarucizumab is ineffective against Xa-inhibitors; instead, different directly acting antidotes are being developed, including andexanet alfa and PER977. First results are also positive with these agents, and larger-scale clinical trials are anticipated within the year 2016. While these drugs clearly represent an important addition to our portfolio, many aspects in the practical use remain to be determined, including the type of patients and conditions requiring reversal and the time of reinstitution of anticoagulation. These and other issues are elegantly...

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3D delayed-enhanced magnetic resonance sequences improve conducting channel delineation prior to ventricular tachycardia ablation

Abstract: 3D scar reconstruction using images from 3D-GRE sequence improves the overall delineation of CC prior to VT ablation.

Cited by 117 publications

References 22 publications

Influence of myocardial scar on the response to frequent premature ventricular complex ablation

Influence of myocardial scar on the response to frequent premature ventricular complex ablation

Sudden Cardiac Death Substrate Imaged by Magnetic Resonance Imaging

The year in cardiology 2015: arrhythmias and device therapy.

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