Evaluation of left ventricular scar identification from contrast enhanced magnetic resonance imaging for guidance of ventricular catheter ablation therapy

M. E. Rettmann, H. I. Lehmann, S. B. Johnson, Douglas L Packer

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

Patients with ventricular arrhythmias typically exhibit myocardial scarring, which is believed to be an important anatomic substrate for reentrant circuits, thereby making these regions a key target in catheter ablation therapy. In ablation therapy, a catheter is guided into the left ventricle and radiofrequency energy is delivered into the tissue to interrupt arrhythmic electrical pathways. Low bipolar voltage regions are typically localized during the procedure through point-by-point construction of an electroanatomic map by sampling the endocardial surface with the ablation catheter and are used as a surrogate for myocardial scar. This process is time consuming, requires significant skill, and has the potential to miss low voltage sites. This has led to efforts to quantify myocardial scar preoperatively using delayed, contrast-enhanced MRI. In this paper, we evaluate the utility of left ventricular scar identification from delayed contrast enhanced magnetic resonance imaging for guidance of catheter ablation of ventricular arrhythmias. Myocardial infarcts were created in three canines followed by a delayed, contrast enhanced MRI scan and electroanatomic mapping. The left ventricle and myocardial scar is segmented from preoperative MRI images and sampled points from the procedural electroanatomical map are registered to the segmented endocardial surface. Sampled points with low bipolar voltage points visually align with the segmented scar regions. This work demonstrates the potential utility of using preoperative delayed, enhanced MRI to identify myocardial scarring for guidance of ventricular catheter ablation therapy.

Original languageEnglish (US)
Title of host publicationMedical Imaging 2016: Image-Guided Procedures, Robotic Interventions, and Modeling
PublisherSPIE
Volume9786
ISBN (Electronic)9781510600218
DOIs
StatePublished - 2016
EventMedical Imaging 2016: Image-Guided Procedures, Robotic Interventions, and Modeling - San Diego, United States
Duration: Feb 28 2016Mar 1 2016

Other

OtherMedical Imaging 2016: Image-Guided Procedures, Robotic Interventions, and Modeling
CountryUnited States
CitySan Diego
Period2/28/163/1/16

ASJC Scopus subject areas

  • Atomic and Molecular Physics, and Optics
  • Electronic, Optical and Magnetic Materials
  • Biomaterials
  • Radiology Nuclear Medicine and imaging

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  • Cite this

    Rettmann, M. E., Lehmann, H. I., Johnson, S. B., & Packer, D. L. (2016). Evaluation of left ventricular scar identification from contrast enhanced magnetic resonance imaging for guidance of ventricular catheter ablation therapy. In Medical Imaging 2016: Image-Guided Procedures, Robotic Interventions, and Modeling (Vol. 9786). [97862R] SPIE. https://doi.org/10.1117/12.2217200