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- Title
Image Integration Using Intracardiac Ultrasound and 3D Reconstruction for Scar Mapping and Ablation of Ventricular Tachycardia.
- Authors
BUNCH, T. JARED; WEISS, J. PETER; CRANDALL, BRIAN G.; DAY, JOHN D.; DIMARCO, JOHN P.; FERGUSON, JOHN D.; MASON, PAMELA K.; McDANIEL, GEORGE; OSBORN, JEFFREY S.; WIGGINS, DAVE; MAHAPATRA, SRIJOY
- Abstract
Background: Ablation of ventricular tachycardia (VT) reduces implantable cardioverter defibrillator shocks. Intracardiac ultrasound (ICE) can visualize and quantify the function of all left ventricular wall segments. We thus hypothesized that ICE could identify scar tissue and provide a guide to facilitate substrate-guided VT ablation. Methods: Eighteen patients underwent VT ablation with real time ICE mapping from the right atrium and ventricle with online 3D-image reconstruction of scar segments. The left ventricle was also scar mapped by traditional electroanatomic mapping (CARTO) for comparison. Images from these 2 scar mapping techniques were compared to each other as well as to a preprocedure transthoracic echocardiogram. Results: The average age was 65 ± 12 years and 12 (67%) were male (15 [83%] had ischemic cardiomyopathy). Two patients (12%) had recurrence of their clinical VT (1 remained on an antiarrhythmic medication, the other had a repeat ablation) over a follow-up of 127 ± 33 days. No periprocedural or long-term adverse events occurred. A total of 248 wall segments were analyzed. All 3 modalities were concordant in scar identification in 193 (78%) segments. The ICE segments correlated with the electroanatomic map in 213 (86%) segments versus 198 (80%), which correlated with transthoracic echocardiography and electroanatomic mapping (P = 0.046). Specifically, the ICE wall motion scores were closer to the electroanatomic mapping in the basal segments and showed a higher accuracy in ischemic heart disease. Conclusion: These data demonstrate that real time ICE images provide accurate chamber geometries and scar boundaries of the left ventricle. These scar borders were more accurate than transthoracic echocardiography and illustrate the feasibility of ICE for substrate-based ablation for VT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 678-684, June 2010)
- Subjects
VENTRICULAR tachycardia; ECHOCARDIOGRAPHY; CATHETER ablation; DISEASE mapping; IMPLANTABLE cardioverter-defibrillators; CARDIAC imaging; THERAPEUTICS
- Publication
Journal of Cardiovascular Electrophysiology, 2010, Vol 21, Issue 6, p678
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/j.1540-8167.2009.01680.x