Computational Re-Entry Vulnerability Index Mapping to Guide Ablation in Patients With Postmyocardial InfarctionVentricular Tachycardia.

Abstract

Ventricular tachycardias (VTs) in patients with myocardial infarction (MI) are often treated with catheter ablation. However, the VT induction during this procedure does not always identify all of the relevant activationpathways or may not be possible or tolerated. The re-entry vulnerability index (RVI) quantifies regional activation-repolarization differences and can detect multiple regions susceptible to re-entry without the need to inducethe arrhythmia. This study aimed to further develop and validate the RVI mapping in patient-specific computational models of post-MI VTs. Cardiac magnetic resonance imaging data from 4 patients with post-MI VTs were used to induce VTs inacomputational electrophysiological model by pacing. The RVI map of a premature beat in each patient modelwasused to guide virtual ablations. We compared our results with those of clinical ablation in the same patients. Single-site virtual RVI-guided ablation prevented VT induction in 3 of 9 cases. Multisite virtual ablations guided by RVI mapping successfully prevented re-entry in all cases (9 of 9). Overall, virtual ablation required 15-fold fewer ablation sites (235.5 ± 97.4 vs 17.0 ± 6.8) and 2-fold less ablation volume (5.34 ± 1.79mL vs 2.11 ± 0.65mL) than the clinical ablation. RVI mapping allows localization of multiple regions susceptible to re-entry and may help guide VT ablation. RVI mapping does not require the induction of arrhythmia and may result in less ablated myocardial volumeswith fewer ablation sites.