Substrate characterization for ventricular tachycardia ablation using a new image processing service
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LETTER TO THE EDITORS
Substrate characterization for ventricular tachycardia ablation using a new image processing service Florian Spies1 · Michael Kühne1 · Christian Sticherling1 · Sven Knecht1 Received: 7 August 2020 / Accepted: 30 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Sirs: Catheter ablation (CA) is a well-established therapy for the treatment of scar-related ventricular tachycardia (VT). In hemodynamically unstable VTs, strategies such as dechanneling, LAVAs abolition or encircling of low voltage areas have been demonstrated to have similar success rates in terms of freedom of VT [1]. The latest guidelines on ventricular arrhythmia management [2] recommend to perform CA in combination with a 3D electroanatomical mapping (EAM) system and the integration of pre-procedural cardiac imaging such as computed tomography (CT) or magnetic resonance imaging (MRI). These imaging technologies can help to identify the potential substrate based in the assessment of myocardial wall thickness from cardiac CT or myocardial fibrosis from late-gadolinium enhanced MRI or late-enhancement CT acquisitions [3]. However, image processing and 3D reconstruction is a time-consuming task requiring experienced specialists and a dedicated software. Recently, a cloud-based image-processing service covering this entire task (https://www.inhear t.fr) received the CE-certificate for its service. We describe the first clinical experience with this new cardiac imaging service outside of the developers group. The aim of the study was to present an independent evaluation of this service to predict the ventricular bipolar low voltage areas based on wall thickness reconstructions from pre-procedural CT scans. We included six consecutive patients (pts) with ischemic cardiomyopathy that underwent standardized pre-procedural cardiac CT of the entire ECG-cycle with additional lateenhancement series (Siemens, Germany) prior to CA procedure. Image dataset were anonymized with the provided software and uploaded to the platform. After processing by * Sven Knecht [email protected] 1
Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
the company, the dataset of the reconstructed 3D cardiac anatomy was downloaded and included in the 3D EAM system (CARTO3, Biosense Webster, USA) prior to ablation. During CA, bipolar voltage mapping using the 3D EAM system was performed in sinus rhythm using a 3.5 mm open-irrigated tip catheter (ThermoCool Smart Touch, NaviStar RMT ThermoCool) (Biosense Webster, USA) and a multipolar mapping catheter (PENTARAY, Biosense Webster, USA). A minimum of 350 left ventricular voltage points was available for every patient. Merging of the 3D EAM and reconstructed cardiac anatomy was performed based on the LV apex, the mitral annulus and the aorta. Scar and scar border zone was defined based on a bipolar voltage
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