Document Detail

Magnetic resonance-based anatomical analysis of scar-related ventricular tachycardia: implications for catheter ablation.
MedLine Citation:
PMID:  17916777     Owner:  NLM     Status:  MEDLINE    
In catheter ablation of scar-related monomorphic ventricular tachycardia (VT), substrate voltage mapping is used to electrically define the scar during sinus rhythm. However, the electrically defined scar may not accurately reflect the anatomical scar. Magnetic resonance-based visualization of the scar may elucidate the 3D anatomical correlation between the fine structural details of the scar and scar-related VT circuits. We registered VT activation sequence with the 3D scar anatomy derived from high-resolution contrast-enhanced MRI in a swine model of chronic myocardial infarction using epicardial sock electrodes (n=6, epicardial group), which have direct contact with the myocardium where the electrical signal is recorded. In a separate group of animals (n=5, endocardial group), we also assessed the incidence of endocardial reentry in this model using endocardial basket catheters. Ten to 12 weeks after myocardial infarction, sustained monomorphic VT was reproducibly induced in all animals (n=11). In the epicardial group, 21 VT morphologies were induced, of which 4 (19.0%) showed epicardial reentry. The reentry isthmus was characterized by a relatively small volume of viable myocardium bound by the scar tissue at the infarct border zone or over the infarct. In the endocardial group (n=5), 6 VT morphologies were induced, of which 4 (66.7%) showed endocardial reentry. In conclusion, MRI revealed a scar with spatially complex structures, particularly at the isthmus, with substrate for multiple VT morphologies after a single ischemic episode. Magnetic resonance-based visualization of scar morphology would potentially contribute to preprocedural planning for catheter ablation of scar-related, unmappable VT.
Hiroshi Ashikaga; Tetsuo Sasano; Jun Dong; M Muz Zviman; Robert Evers; Bruce Hopenfeld; Valeria Castro; Robert H Helm; Timm Dickfeld; Saman Nazarian; J Kevin Donahue; Ronald D Berger; Hugh Calkins; M Roselle Abraham; Eduardo Marbán; Albert C Lardo; Elliot R McVeigh; Henry R Halperin
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2007-10-04
Journal Detail:
Title:  Circulation research     Volume:  101     ISSN:  1524-4571     ISO Abbreviation:  Circ. Res.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-30     Completed Date:  2007-11-21     Revised Date:  2011-01-10    
Medline Journal Info:
Nlm Unique ID:  0047103     Medline TA:  Circ Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  939-47     Citation Subset:  IM    
Division of Cardiology, Johns Hopkins University School of Medicine, 720 Rutland Ave, Traylor 903, Baltimore, MD 20215, USA.
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MeSH Terms
Catheter Ablation / adverse effects*
Cicatrix / etiology*,  pathology*,  physiopathology
Magnetic Resonance Imaging / methods*
Myocardium / pathology
Sus scrofa
Tachycardia, Ventricular / etiology*,  pathology*,  physiopathology
Grant Support
P01 HL077180-02/HL/NHLBI NIH HHS; P01-HL077180/HL/NHLBI NIH HHS; R01 HL064795-08/HL/NHLBI NIH HHS; R01-HL64795/HL/NHLBI NIH HHS; Z01 HL004609-04/HL/NHLBI NIH HHS; Z01-HL004609/HL/NHLBI NIH HHS

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