Abstract
The underlying mechanisms of ventricular tachycardia (VT) are not well understood. Most models for VT propagation are based on animal studies or single surface recordings which have limited utility. Human based investigations of VT are often limited by hemodynamic collapse and lack viable ways to assess the myocardial electrical propagation. The authors seek to provide a novel method for the experimental evaluation of VT in human hearts with correlation to high resolution MRI fibrosis imaging. Human donor hearts were obtained from discarded transplant specimens. Following explant, the hearts were cannulated to the Langendorff apparatus and ventricular tachycardia was induced using a programmed ventricular stimulation protocol. Custom built 3D printed epicardial and endocardial mapping probes were deployed to map whole ventricular contraction. The hearts were imaged using high-resolution late gadolinium enhancement 4T MRI for fibrosis quantitation. A total of 8 human hearts underwent complete mapping procedures with 3 spontaneously beating VT hearts and 5 control hearts. High resolution mapping demonstrated VT originated from epicardial regions in all 3 hearts. Site of origin of VT was identified in all 3 human hearts and correlated to MRI fibrosis mapping. This study highlights new methods for the interrogation of ventricular tachycardia substrates using a novel human Langendorff heart model. The integration of mapping and imaging techniques in this study provides new insights into the mechanisms underlying VT. These efforts may help clinicians to provide more targeted ablation procedures.
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