Author + information
- Received June 26, 2019
- Revision received November 8, 2019
- Accepted November 11, 2019
- Published online February 26, 2020.
- David Soto-Iglesias, PhDa,b,
- Diego Penela, MD, PhDc,
- Beatriz Jáuregui, MDa,
- Juan Acosta, MD, PhDd,
- Juan Fernández-Armenta, MD, PhDe,
- Markus Linhart, MDb,
- Giulio Zucchelli, MD, PhDf,
- Vladimir Syrovnev, MDb,
- Fatima Zaraket, MDb,
- Cheryl Terés, MDa,
- Rosario J. Perea, MD, PhDb,
- Susana Prat-González, MD, PhDb,
- Ada Doltra, MD, PhDb,
- José T. Ortiz-Pérez, MD, PhDb,
- Xavier Bosch, MD, PhDb,
- Oscar Camara, PhDg and
- Antonio Berruezo, MD, PhDa,b,∗ ()
- aHeart Institute, Teknon Medical Center, Barcelona, Spain
- bHospital Puerta del Mar, Cádiz, Spain
- cOspedale Guglielmo da Saliceto, Piacenza, Italy
- dHospital Universitario Virgen del Rocío, Sevilla, Spain
- eClinic Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
- fAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- gPhysense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain
- ↵∗Address for correspondence:
Dr. Antonio Berruezo, Heart Institute, Teknon Medical Center, C/ Vilana, 12, 08022 Barcelona, Spain.
Objectives This study assessed the feasibility and potential benefit of performing ventricular tachycardia (VT) substrate ablation procedures guided by cardiac magnetic resonance (CMR)−derived pixel signal intensity (PSI) maps.
Background CMR-aided VT ablation using PSI maps from late gadolinium enhancement−CMR (LGE-CMR), together with electroanatomical map (EAM) information, has been shown to improve outcomes of VT substrate ablation.
Methods Eighty-four patients with scar-dependent monomorphic VT who underwent substrate ablation were included in the study. In the last 28 (33%) consecutive patients, the procedure was guided by CMR. Procedural data, as well as acute and follow-up outcomes, were compared between patients who underwent guided CMR and 2 control groups: 1) patients who had PSI maps were available but the EAM was acquired and used to select the ablation targets (CMR aided); and 2) patients with no CMR-derived PSI maps available (no CMR).
Results Mean procedure duration was lower in CMR-guided substrate ablation compared with CMR-aided and no CMR (107 ± 59 min vs. 203 ± 68 min and 227 ± 52 min; p < 0.001 for both comparisons). CMR-guided ablation required less fluoroscopy time than CMR-aided ablation and no CMR (10 ± 4 min vs. 23 ± 11 min and 20 ± 9 min, respectively; p < 0.001 for both comparisons) and less radiofrequency time (15 ± 8 min vs. 20 ± 15 min and 26 ± 10 min; p = 0.16 and p < 0.001, respectively). After substrate ablation, VT inducibility was lower in CMR-guided ablation compared with CMR-aided ablation and no CMR (18% vs. 32% and 46%; p = 0.35 and p = 0.04, respectively), without significant differences in complications. After 12 months, VT recurrence was lower in those who underwent CMR-guided ablation compared with no CMR (log-rank: 0.019), with no differences with CMR-aided ablation.
Conclusions CMR-guided VT ablation is feasible and safe, significantly reduces the procedural, fluoroscopy, and radiofrequency times, and is associated with a higher non-inducibility rate and lower VT recurrence after substrate ablation.
This work was supported by Agencia de Gestió d’Ajuts Universitaris i de Recerca, Generalitat de Catalunya (grant 2014-SGR-471), Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red: FIS-CIBER16 (grant CB16/11/00354), Fondo de Investigación Sanitaria (grants PI14/00759 and PI17/01968), and Ministerio de Economía y Competitividad, RETOS (grants RTC-2015-3515-1 and RTC-2016-5445-1). Drs. Soto-Iglesias and Penela contributed equally to this work and are joint first authors. Dr. Berruezo holds stock in Galgo Medical SL; and has received financial support from Siemens Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 26, 2019.
- Revision received November 8, 2019.
- Accepted November 11, 2019.
- 2020 American College of Cardiology Foundation
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