Abstract
Geometrical structure of the myocardium plays an important role in understanding the generation of arrhythmias. In particular, a heterogeneous tissue (HT) channel defined in cardiovascular magnetic resonance (CMR) has been suggested to correlate with conduction channels defined in electroanatomic mapping in ventricular tachycardia (VT). Despite the potential of CMR for characterization of the arrhythmogenic substrate, there is currently no standard approach to identify potential conduction channels. Therefore, we sought to develop a workflow to identify HT channel based on the structural 3D modeling of the viable myocardium within areas of dense scar. We focus on macro-level HT channel detection in this work. The proposed technique was tested in high-resolution ex-vivo CMR images in 20 post-infarct swine models who underwent an electrophysiology study for VT inducibility. HT channel was detected in 15 animals with inducible VT, whereas it was only detected in 1 out of 5 animal with non-inducible VT (P < 0.01, Fisher’s exact test). The HT channel detected in the non-inducible animal was shorter than those detected in animals with inducible VTs (inducible-VT animals: 35 ± 14 mm vs. non-inducible VT animal: 9.94 mm). Electrophysiology study and histopathological analyses validated the detected HT channels. The proposed technique may provide new insights for understanding the macro-level VT mechanism.
Highlights
The importance of myocardial structure in arrhythmias has led cardiovascular magnetic resonance (CMR) to a promising technique for identifying the arrhythmogenic substrate
We propose a technique for 3D heterogeneous tissue (HT) channel detection based on 3D structural modeling of the viable myocardium using high-resolution ex-vivo CMR (Fig. 1a)
More detailed localization of the ventricular tachycardia (VT) origin was identified in electro-anatomic mapping (EAM) by activation mapping during the VT in 3 animals, which was compared to the location of the detected HT channels
Summary
The importance of myocardial structure in arrhythmias has led cardiovascular magnetic resonance (CMR) to a promising technique for identifying the arrhythmogenic substrate. The proposed technique was tested in high-resolution ex-vivo CMR images in 20 swine models with VT following myocardial infarction, and validated by electrophysiology and histopathological analyses. We propose a technique for 3D HT channel detection based on 3D structural modeling of the viable myocardium using high-resolution ex-vivo CMR (Fig. 1a).
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