Circ Arrhythm Electrophysiol

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Presentation transcript:

Circ Arrhythm Electrophysiol Integration of 3D Electroanatomic Maps and Magnetic Resonance Scar Characterization Into the Navigation System to Guide Ventricular Tachycardia AblationClinical Perspective by David Andreu, Antonio Berruezo, José T. Ortiz-Pérez, Etelvino Silva, Lluis Mont, Roger Borràs, Teresa María de Caralt, Rosario Jesús Perea, Juan Fernández-Armenta, Hrvojka Zeljko, and Josep Brugada Circ Arrhythm Electrophysiol Volume 4(5):674-683 October 18, 2011 Copyright © American Heart Association, Inc. All rights reserved.

Algorithms applied to a contrast-enhanced cardiac magnetic resonance (CE-CMR) image. Algorithms applied to a contrast-enhanced cardiac magnetic resonance (CE-CMR) image. A, Manual segmentation applied to a CE-CMR image, both left ventricle endocardium and scar (white and red areas, respectively). B, C, and D, Same images postprocessed by an algorithm using 50%, 60%, and 70% of maximum signal intensity, respectively. David Andreu et al. Circ Arrhythm Electrophysiol. 2011;4:674-683 Copyright © American Heart Association, Inc. All rights reserved.

Area measurement method. Area measurement method. A, CORE scar area measurement of the electroanatomic voltage map is being made over the projection on the left ventricle cardiac magnetic resonance–derived structure. B, Area measurement of the CORE of the 3D scar structure derived from the cardiac magnetic resonance acquisition. David Andreu et al. Circ Arrhythm Electrophysiol. 2011;4:674-683 Copyright © American Heart Association, Inc. All rights reserved.

Comparison between regression lines using different cutoff values. Comparison between regression lines using different cutoff values. A, Regression lines for the 3D-CORE structures using values of 50%, 60%, and 70% of the maximum signal intensity (MSI) and 60% MSI considering only the subendocardial half-wall thickness. B, Regression lines for the 3D border zone (BZ) structures using values of 50%, 60%, and 70% MSI and 60% MSI and considering only the subendocardial half-wall thickness. β coefficient indicates slope of the regression line); MSE, mean square error; and r2, square Pearson coefficient. David Andreu et al. Circ Arrhythm Electrophysiol. 2011;4:674-683 Copyright © American Heart Association, Inc. All rights reserved.

Bland-Altman plots of measures using the most relevant cutoff values. Bland-Altman plots of measures using the most relevant cutoff values. A1 and A2, Bland-Altman plots using a cutoff value of 60% of maximum signal intensity (MSI) for the CORE and border zone (BZ), respectively. B1 and B2, Bland-Altman plots using a cutoff value of 70% of MSI for the CORE and BZ, respectively (units are cm2). David Andreu et al. Circ Arrhythm Electrophysiol. 2011;4:674-683 Copyright © American Heart Association, Inc. All rights reserved.

Comparison between electroanatomic voltage maps and contrast-enhanced cardiac magnetic resonance (CE-CMR)-derived structures for all cases. Comparison between electroanatomic voltage maps and contrast-enhanced cardiac magnetic resonance (CE-CMR)-derived structures for all cases. The CE-CMR structures were obtained using a cutoff value of 60% maximum signal intensity with only the subendocardial half-wall. Image 10 shows the epicardial case. David Andreu et al. Circ Arrhythm Electrophysiol. 2011;4:674-683 Copyright © American Heart Association, Inc. All rights reserved.

Comparison of 3D contrast-enhanced cardiac magnetic resonance (CE-CMR)-derived scar reconstructions with different cutoff values. Comparison of 3D contrast-enhanced cardiac magnetic resonance (CE-CMR)-derived scar reconstructions with different cutoff values. Endocardial view of the scar on the electroanatomic map and the same view of the 3D CE-CMR–derived scar reconstruction. Panel 1, Scar reconstruction obtained using 60% of the maximum signal intensity (MSI) and considering only the subendocardial half-wall thickness. White arrows show the ventricular tachycardia (VT)-related conducting channel inside the scar. Radiofrequency ablation lesions were deployed at this level, rendering the VT noninducible. Panel 2, Scar reconstruction using the 50% MSI. In this case, no conducting channel is observed. Panel 3, Scar reconstruction using the 70% MSI. In this case, a less accurate delineation of the conducting channel can be observed. David Andreu et al. Circ Arrhythm Electrophysiol. 2011;4:674-683 Copyright © American Heart Association, Inc. All rights reserved.

Final aspect of scar segmentation using the best cutoff value integrated into the navigation system (patient 5). Final aspect of scar segmentation using the best cutoff value integrated into the navigation system (patient 5). David Andreu et al. Circ Arrhythm Electrophysiol. 2011;4:674-683 Copyright © American Heart Association, Inc. All rights reserved.