Original-clinicalImaging/mappingInfarct architecture and characteristics on delayed enhanced magnetic resonance imaging and electroanatomic mapping in patients with postinfarction ventricular arrhythmia
Section snippets
Patient characteristics (Table 1)
Fourteen consecutive patients were included in this study. The study was approved by the institutional review committees of both institutions.
MRI
All patients had MRI studies within 2 weeks before the ablation procedure. The studies were performed on a 1.5 Tesla MRI scanner (Signa Excite CV/i, General Electric, Milwaukee, WI) with a 4- or 8-element phased-array coil placed over the chest of patients in supine position. Images were acquired with electrocardiogram (ECG) gating during breath holds.
Patient characteristics
The patient characteristics are described in Table 1. The subjects of this study were 14 consecutive postinfarction patients referred for radiofrequency ablation of recurrent VT (n = 9) or symptomatic frequent PVCs (n = 5) that were refractory to medical treatment. None of the patients had a cardioverter-defibrillator at the time of hospital admission. One patient was being treated with amiodarone, and the other patients were not taking antiarrhythmic drugs other than a beta-blocker or calcium
Main findings
The unique aspect of this study is the demonstration that sites critical to reentrant ventricular arrhythmias in humans are located within areas of DE by MRI. Scar can be selectively extracted from DE-MRIs and registered into the EA mapping system using customized software. Areas enhancing with DE-MRI have distinct electrophysiologic characteristics as compared with nonenhancing sites.
Scar extraction and registration
This study demonstrated a high degree of correlation between endocardial EA voltage mapping and scar as
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This study was supported by National Institutes of Health grant no. 7K23EB006481 (to BD).