title: Image Integration to Guide Catheter Ablation in Scar-Related Ventricular Tachycardia.
abstract: Although multi-detector computed tomography (MDCT) and cardiac magnetic resonance (CMR) can assess the structural substrate of ventricular tachycardia (VT) in ischemic cardiomyopathy (ICM), non-ICM (NICM), and arrhythmogenic right ventricular cardiomyopathy (ARVC), the usefulness of systematic image integration during VT ablation remains undetermined.
  
  
  
  A total of 116 consecutive patients (67 ICM; 30 NICM; 19 ARVC) underwent VT ablation with image integration (MDCT 91%; CMR 30%; both 22%). Substrate was defined as wall thinning on MDCT and late gadolinium-enhancement on CMR in ICM/NICM, and as myocardial hypo-attenuation on MDCT in ARVC. This substrate was compared to mapping and ablation results with the endpoint of complete elimination of local abnormal ventricular activity (LAVA), and the impact of image integration on procedural management was analyzed. Imaging-derived substrate identified 89% of critical VT isthmuses and 85% of LAVA, and was more efficient in identifying LAVA in ICM and ARVC than in NICM (90% and 90% vs. 72%, P < 0.0001), and when defined from CMR than MDCT (ICM: 92% vs. 88%, P = 0.026, NICM: 88% vs. 72%, P < 0.001). Image integration motivated additional mapping and epicardial access in 57% and 33% of patients. Coronary and phrenic nerve integration modified epicardial ablation strategy in 43% of patients. The impact of image integration on procedural management was higher in ARVC/NICM than in ICM (P < 0.01), and higher in case of epicardial approach (P < 0.0001).
  
  
  
  Image integration is feasible in large series of patients, provides information on VT substrate, and impacts procedural management, particularly in ARVC/NICM, and in case of epicardial approach.
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Seigo
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.|IHU LIRYC-Equipex MUSIC, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sacher
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Saagar
authors.initials: S
authors.lastname: Mahida
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Berte
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Han S
authors.initials: HS
authors.lastname: Lim
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Sana
authors.initials: S
authors.lastname: Amraoui
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.|IHU LIRYC-Equipex MUSIC, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.|IHU LIRYC-Equipex MUSIC, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.|IHU LIRYC-Equipex MUSIC, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: François
authors.initials: F
authors.lastname: Laurent
authors.affiliation: Inria, Asclepios team, Sophia Antipolis, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Sermesant
authors.affiliation: Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.|IHU LIRYC-Equipex MUSIC, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Montaudon
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.|IHU LIRYC-Equipex MUSIC, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.|IHU LIRYC-Equipex MUSIC, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.|IHU LIRYC-Equipex MUSIC, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.affiliation: Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.|IHU LIRYC-Equipex MUSIC, Université de Bordeaux-Inserm U1045, Pessac, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Cochet
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D009202:Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation; D002921:Cicatrix / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003287:Contrast Media / Q000008:administration & dosage; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D007479:Iopamidol / Q000008:administration & dosage / Q000031:analogs & derivatives; D008279:Magnetic Resonance Imaging; D008297:Male; D008536:Meglumine / Q000008:administration & dosage; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D064847:Multimodal Imaging / Q000379:methods*; D009942:Organometallic Compounds / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C057937:iomeprol; D008536:Meglumine; D007479:Iopamidol; C072417:gadoterate meglumine
keywords: CMR; MDCT; ablation; imaging; scar-related ventricular tachycardia