Standard Ablation Versus Magnetic Resonance Imaging-Guided Ablation in the Treatment of Ventricular Tachycardia

被引:47
作者
Zghaib, Tarek [2 ]
Ipek, Esra G. [2 ]
Hansford, Rozann [2 ]
Ashikaga, Hiroshi [2 ]
Berger, Ronald D. [2 ]
Marine, Joseph E. [2 ]
Spragg, David D. [2 ]
Tandri, Harikrishna [2 ]
Zimmerman, Stefan L. [3 ]
Halperin, Henry [2 ,3 ,4 ]
Brancato, Scott [5 ]
Calkins, Hugh [2 ]
Henrikson, Charles [2 ,6 ]
Nazarian, Saman [1 ]
机构
[1] Univ Penn, Div Cardiol, Perelman Sch Med, 3400 Spruce St,Founders 9124, Philadelphia, PA 19104 USA
[2] Johns Hopkins Univ, Div Cardiol, Sch Med, Baltimore, MD USA
[3] Johns Hopkins Med, Dept Radiol & Radiol Sci, Baltimore, MD USA
[4] Johns Hopkins Univ, Dept Biomed Engn, Baltimore, MD USA
[5] Providence St Vincent Med Ctr, Dept Cardiol, Portland, OR USA
[6] Oregon Hlth & Sci Univ, Div Cardiol, Portland, OR USA
基金
美国国家卫生研究院;
关键词
cardiomyopathies; catheter ablation; electrophysiology; magnetic resonance imaging; tachycardia; ventricular; INTEGRATION;
D O I
10.1161/CIRCEP.117.005973
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Radiofrequency ablation is an effective treatment strategy for ischemic and nonischemic cardiomyopathy-related ventricular tachycardia (VT). The role of substrate-guided ablation, performed using electrogram characteristics (low amplitude, fractionated or isolated potentials) as scar surrogates, is expanding because of frequent hemodynamic instability during entrainment mapping of scarrelated VT. Late gadolinium-enhancement on cardiac magnetic resonance imaging (LGE-MRI) can accurately characterize the transmural extent, location, and configuration of ventricular scar.(1) Integration of LGE-MRI into electroanatomical mapping during VT ablation was shown, in preliminary studies, to be feasible and to provide accurate localization of VT substrate and reentry circuits. 2-4 However, studies to date examining the impact of MRI scar integration on procedural outcomes have lacked control groups, precluding any comparisons with standard practice. We performed a study to (1) demonstrate the feasibility in clinical practice of integrating MRI-derived scar for guidance of VT ablation; (2) report on the periprocedural performance of LGE-MRI in identifying the arrhythmogenic substrate; and (3) examine the impact of MRI-guided ablation on procedural length and acute and long-term outcomes.
引用
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页数:4
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