VT Highlighted case: March 2018

Our highlighted case is about a patient with ischemic cardiomyopathy.

Clinical background of the patient:

  • Anterior infarction 28 years prior to ablation
  • Lateral infarction 9 years prior to ablation
  • Left Ventricle Ejection Fraction: 35%

Intervention Planning

The myocardial tissue was characterized with the analysis of LGE-MRI using ADAS-VT. The patient presented two separate scar areas:

Anterior scar

The anterior scar consisted of:

  • 8.63 grams of dense scar tissue (red)
  • 15.94 grams of mild fibrotic tissue (gradient)

Because of the scar's transmurality a combined endo/epicardial approach was taken.

Lateral scar

The lateral scar was not transmural and consisted of:

  • 8.35 grams of dense scar tissue (red)
  • 8.93 grams of mild fibrotic tissue (gradient)

Channels

Three Border-Zone corridors were detected:

  • Channel 1: Lateral (2.06 grams)
  • Channel 2: Anterior apical (1.99 grams)
  • Channel 3: Anterior mid-wall (2.40 grams)

CT segmentation

The CT was coregistered with the LGE-MRI and the cardiac anatomy and adjacent structures were segmented to aid the fusion of the electro-anatomical map (EAM) with the substrate information in the navigation system.

Gallery

Intervention

Thanks to the identification of the VT substrate provided by ADAS-VT the mapping could be focused on the scar region and the Border-Zone corridors, so that the procedure time was reduced.

Carto during intervention

The substrate and anatomical information from ADAS was imported into the navigation system and registered using a fast activation map of the aortic root.

The Border-Zone corridors identified by ADAS-VT matched with electrograms with delayed components that qualify to be considered CC-entrances during sinus rhythm in the EAM.

Case Review

The electro-anatomical map was imported into ADAS-VT to contrast the findings with the LGE-MRI data.

Review after procedure

ADAS-VT provided statistics about:

  • Similarity between image intensity and voltage maps
  • Distance of interesting EAM points to channels

Case Courtesy of Dr Antonio Berruezo, Arrhythmia Section, Hospital Clínic de Barcelona, Spain

Hospital Clínic de Barcelona

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