Feasibility of image-based simulation to estimate ablation target in human ventricular arrhythmia

Abstract

Background Previous studies suggest that MRI with late gadolinium enhancement (LGE) may identify slowly conducting tissues in scar-related ventricular tachycardia (VT). Objective We tested the feasibility of image-based simulation based on LGE to estimate ablation targets in VT. Methods We conducted a retrospective study in 13 patients who had pre-ablation MRI for scar-related VT ablation. We used image-based simulation to induce VT and estimate target regions according to the simulated VT circuit. The estimated target regions were co-registered with the LGE scar map and the ablation sites from the electroanatomical map in the standard ablation approach. Results In image-based simulation, VT was inducible in 12 patients (92.3%). All VTs showed macro-reentrant propagation patterns, and the narrowest width of estimated target region that an ablation line should span to prevent VT recurrence was 5.0 ± 3.4 mm. Out of 11 patients who underwent ablation, the results of image-based simulation and the standard approach were consistent in 9 patients (82%), where ablation within the estimated target region was associated with acute success (n=8) and ablation outside the estimated target region was associated with failure (n=1). In one case (9%), the results of image-based simulation and the standard approach were inconsistent, where ablation outside the estimated target region was associated with acute success. Conclusions The image-based simulation can be used to estimate potential ablation targets of scar-related VT. The image-based simulation may be a powerful noninvasive tool for pre-procedural planning of ablation procedures to potentially reduce the procedure time and complication rates.

A feasibility study of arrhythmia risk prediction in patients with myocardial infarction and preserved ejection fraction

“…11 That retrospective study demonstrated that VARP results are superior to other current non-invasive clinical metrics, such as LVEF, grey zone volume, 26 scar volume, 27 or left ventricular mass, 28 as well as to the invasive EP testing. These results point to the translational potential of VARP in being used as an effective patient selection tool for prophylactic ICD implantation.…”

Optogenetic defibrillation terminates ventricular arrhythmia in mouse hearts and human simulations

“…Electrophysiology of normal and diseased human cardiac tissue was represented using an extensively validated approach (35). Briefly, cell-and tissue-scale properties were assigned to all 3 regions in the ventricular mesh: normal myocardium, PIZ, and infarct.…”

“…We used a computational model of the diseased human ventricles reconstructed from clinical late gadolinium-enhanced MRI (LGE-MRI) scans of a patient with post-myocardial infarction VT (33). The modeling approach has been previously validated in infarct-related VT inducibility studies (12,34,35). Our laboratory pipeline for cardiac model reconstruction has been described in detail in previous work (12,(34)(35)(36)(37).…”

“…The modeling approach has been previously validated in infarct-related VT inducibility studies (12,34,35). Our laboratory pipeline for cardiac model reconstruction has been described in detail in previous work (12,(34)(35)(36)(37). Briefly, anatomical landmark points on the epicardial and endocardial walls were identified manually in each LGE-MRI slice.…”

Spiral-wave Instability in a Medium with a Gradient in the Fibroblast Density: a Computational Study

“…Many studies have been performed to investigate the effects of fibroblasts on wave dynamics in cardiac tissue [6,7]; however, most of the studies, which consider fibroblast-myocyte (FM) coupling, deal with a homogeneous distribution of fibroblasts in the domain. But, the density of fibroblasts in a diseased cardiac tissue may not necessarily be homogeneous [8]. Therefore, it is important to study the effects of FM coupling on wave dynamics in a domain with heterogeneous distributions of fibroblast density.…”