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Predicting arrhythmia recurrence following catheter ablation for ventricular tachycardia using late gadolinium enhancement magnetic resonance imaging: Implications of varying scar ranges

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Pranav Bhagirath, Fernando O. Campos, Caroline M. Costa, Arthur A.M. Wilde, Anton J. Prassl, Aurel Neic, Gernot Plank, Christopher A. Rinaldi, Marco J.W. Götte, Martin J. Bishop

Original languageEnglish
Pages (from-to)1604-1610
Number of pages7
JournalHeart Rhythm
Volume19
Issue number10
Early online date26 May 2022
DOIs
Accepted/In press16 May 2022
E-pub ahead of print26 May 2022
PublishedOct 2022

Bibliographical note

Funding Information: Funding Sources: This work was supported by an EACVI Research Grant to Dr Bhagirath. The research was also supported by an Academy Van Leersum grant of the Academy Medical Sciences Fund (Royal Netherlands Academy of Arts & Sciences), Netherlands Heart Institute Fellowship, NIHR Biomedical Research Centre and CRF at Guy's and St Thomas’ NHS Foundation Trust and King's College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. This work was also supported by the Wellcome Trust, Wellcome EPSRC Centre for Medical Engineering at King's College London (WT 203148/Z/16/Z), and a Wellcome Trust Innovator Award to Dr Bishop (213342/Z/18/Z) and British Heart Foundation Project Grant (PG/18/74/34077). For the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. Funding Information: Funding Sources: This work was supported by an EACVI Research Grant to Dr Bhagirath. The research was also supported by an Academy Van Leersum grant of the Academy Medical Sciences Fund (Royal Netherlands Academy of Arts & Sciences), Netherlands Heart Institute Fellowship, NIHR Biomedical Research Centre and CRF at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. This work was also supported by the Wellcome Trust , Wellcome EPSRC Centre for Medical Engineering at King’s College London (WT 203148/Z/16/Z), and a Wellcome Trust Innovator Award to Dr Bishop (213342/Z/18/Z) and British Heart Foundation Project Grant (PG/18/74/34077). For the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. Publisher Copyright: © 2022 Heart Rhythm Society

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Abstract

Background: Thresholding-based analysis of late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) can create scar maps and identify corridors that might provide a reentrant substrate for ventricular tachycardia (VT). Current recommendations use a full-width-at-half-maximum approach, effectively classifying areas with a pixel signal intensity (PSI) >40% as border zone (BZ) and >60% as core. Objective: The purpose of this study was to investigate the impact of 4 different threshold settings on scar and corridor quantification and to correlate this with postablation VT recurrence. Methods: Twenty-seven patients with ischemic cardiomyopathy who had undergone catheter ablation for VT were included for retrospective analysis. LGE-CMR images were analyzed using ADAS3D LV. Scar maps were created for 4 PSI thresholds (40–60, 35–65, 30–70, and 45–55), and the extent of variation in BZ and core, as well as the number and weight of conduction corridors, were quantified. Three-dimensional representations were reconstructed from exported segmentations and used to quantify the surface area between healthy myocardium and scar (BZ + core), and between BZ and core. Results: A wider PSI threshold was associated with an increase in BZ mass and decrease in scar (P <.001). No significant differences were observed for the total number of corridors and their mass with increasing PSI threshold. The best correlation in predicting arrhythmia recurrence was observed for PSI 45–55 (area under the curve 0.807; P =.001). Conclusion: Varying PSI has a significant impact on quantification of LGE-CMR parameters and may have incremental clinical value in predicting arrhythmia recurrence. Further prospective investigation is warranted to clarify the functional implications of these findings for LGE-CMR–guided ventricular ablation.

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