title: Feasibility of image-based simulation to estimate ablation target in human ventricular arrhythmia.
abstract: BACKGROUND
  Previous studies suggest that magnetic resonance imaging with late gadolinium enhancement (LGE) may identify slowly conducting tissues in scar-related ventricular tachycardia (VT).
  
  
  OBJECTIVE
  To test the feasibility of image-based simulation based on LGE to estimate ablation targets in VT.
  
  
  METHODS
  We conducted a retrospective study in 13 patients who had preablation magnetic resonance imaging for scar-related VT ablation. We used image-based simulation to induce VT and estimate target regions according to the simulated VT circuit. The estimated target regions were coregistered with the LGE scar map and the ablation sites from the electroanatomical map in the standard ablation approach.
  
  
  RESULTS
  In image-based simulation, VT was inducible in 12 (92.3%) patients. All VTs showed macroreentrant propagation patterns, and the narrowest width of estimated target region that an ablation line should span to prevent VT recurrence was 5.0 ± 3.4 mm. Of 11 patients who underwent ablation, the results of image-based simulation and the standard approach were consistent in 9 (82%) patients, where ablation within the estimated target region was associated with acute success (n = 8) and ablation outside the estimated target region was associated with failure (n = 1). In 1 (9%) case, the results of image-based simulation and the standard approach were inconsistent, where ablation outside the estimated target region was associated with acute success.
  
  
  CONCLUSIONS
  The image-based simulation can be used to estimate potential ablation targets of scar-related VT. The image-based simulation may be a powerful noninvasive tool for preprocedural planning of ablation procedures to potentially reduce the procedure time and complication rates.
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. hashika1@jhmi.edu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ashikaga
authors.forename: Hermenegild
authors.initials: H
authors.lastname: Arevalo
authors.forename: Fijoy
authors.initials: F
authors.lastname: Vadakkumpadan
authors.forename: Robert C
authors.initials: RC
authors.lastname: Blake
authors.forename: Jason D
authors.initials: JD
authors.lastname: Bayer
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
authors.forename: M
authors.initials: M
authors.lastname: Muz Zviman
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Tandri
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Berger
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Herzka
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Trayanova
authors.forename: Henry R
authors.initials: HR
authors.lastname: Halperin
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D002921:Cicatrix / Q000601:surgery*; D003198:Computer Simulation; D005240:Feasibility Studies; D005260:Female; D005682:Gadolinium; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000601:surgery*
chemical_list: D005682:Gadolinium
keywords: 3-D; 3-dimensional; Cardiac MRI; Catheter ablation; Computer simulation; ECG; EPS; HZ; ICD; Image-based simulation; LGE; LV; MI; MRI; SI; VT; Ventricular arrhythmia; electrocardiogram/electrocardiographic; electrophysiology study; heterogeneous zone; implantable cardioverter-defibrillator; late gadolinium enhancement; left ventricular; magnetic resonance imaging; myocardial infarction; signal intensity; ventricular tachycardia