title: 3D delayed-enhanced magnetic resonance sequences improve conducting channel delineation prior to ventricular tachycardia ablation.
abstract: OBJECTIVE
  Non-invasive depiction of conducting channels (CCs) is gaining interest for its usefulness in ventricular tachycardia (VT) ablation. The best imaging approach has not been determined. We compared characterization of myocardial scar with late-gadolinium enhancement cardiac magnetic resonance using a navigator-gated 3D sequence (3D-GRE) and conventional 2D imaging using either a single shot inversion recovery steady-state-free-precession (2D-SSFP) or inversion-recovery gradient echo (2D-GRE) sequence.
  
  
  RESULTS
  We included 30 consecutive patients with structural heart disease referred for VT ablation. Preprocedural myocardial characterization was conducted in a 3 T-scanner using 2D-GRE, 2D-SSFP and 3D-GRE sequences, yielding a spatial resolution of 1.4 × 1.4 × 5 mm, 2 × 2 × 5 mm, and 1.4 × 1.4 × 1.4 mm, respectively. The core and border zone (BZ) scar components were quantified using the 60% and 40% threshold of maximum pixel intensity, respectively. A 3D scar reconstruction was obtained for each sequence. An electrophysiologist identified potential CC and compared them with results obtained with the electroanatomic map (EAM). We found no significant differences in the scar core mass between the 2D-GRE, 2D-SSFP, and 3D-GRE sequences (mean 7.48 ± 6.68 vs. 8.26 ± 5.69 and 6.26 ± 4.37 g, respectively, P = 0.084). However, the BZ mass was smaller in the 2D-GRE and 2D-SSFP than in the 3D-GRE sequence (9.22 ± 5.97 and 9.39 ± 6.33 vs. 10.92 ± 5.98 g, respectively; P = 0.042). The matching between the CC observed in the EAM and in 3D-GRE was 79.2%; when comparing the EAM and the 2D-GRE and the 2D-SSFP sequence, the matching decreased to 61.8% and 37.7%, respectively.
  
  
  CONCLUSIONS
  3D scar reconstruction using images from 3D-GRE sequence improves the overall delineation of CC prior to VT ablation.
authors.affiliation: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), C/Villarroel 170, 08036 Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Andreu
authors.affiliation: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), C/Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Jose T
authors.initials: JT
authors.lastname: Ortiz-Pérez
authors.affiliation: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), C/Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Fernández-Armenta
authors.affiliation: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), C/Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Guiu
authors.affiliation: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), C/Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Acosta
authors.affiliation: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), C/Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Susanna
authors.initials: S
authors.lastname: Prat-González
authors.affiliation: Radiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: De Caralt
authors.affiliation: Radiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Rosario J
authors.initials: RJ
authors.lastname: Perea
authors.affiliation: Radiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: César
authors.initials: C
authors.lastname: Garrido
authors.affiliation: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), C/Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.affiliation: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), C/Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.affiliation: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), C/Villarroel 170, 08036 Barcelona, Spain berruezo@clinic.ub.es.
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000473:pathology*; D017115:Catheter Ablation / Q000379:methods; D002921:Cicatrix / Q000209:etiology / Q000473:pathology*; D015331:Cohort Studies; D003287:Contrast Media; D005260:Female; D005355:Fibrosis; D019786:Gadolinium DTPA; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology*; D017202:Myocardial Ischemia / Q000150:complications / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D025321:Surgery, Computer-Assisted; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000473:pathology / Q000601:surgery*
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA
keywords: Conducting channels; Magnetic resonance imaging; Ventricular tachycardia ablation