Feasibility study shows concordance between image‐based virtual‐heart ablation targets and predicted ECG‐based arrhythmia exit‐sites

• Published in: Pacing and clinical electrophysiology 2021-03, Vol.44 (3), p.432-441
• Main Authors: Zhou, Shijie, Sung, Eric, Prakosa, Adityo, Aronis, Konstantinos N., Chrispin, Jonathan, Tandri, Harikrishna, AbdelWahab, Amir, Horáček, B. Milan, Sapp, John L., Trayanova, Natalia A.
• Format: Article
• Language: English
• Subjects: Ablation; Arrhythmia; Cardiac arrhythmia; Cardiomyopathy; ECG; EKG; Feasibility studies; Heart; Ischemia; ischemic cardiomyopathy; late gadolinium‐enhanced cardiac magnetic resonance imaging; Lesions; Localization; radiofrequency (RF) ablation; ventricular tachycardia
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14181

Introduction We recently developed two noninvasive methodologies to help guide VT ablation: population‐derived automated VT exit localization (PAVEL) and virtual‐heart arrhythmia ablation targeting (VAAT). We hypothesized that while very different in their nature, limitations, and type of ablation targets (substrate‐based vs. clinical VT), the image‐based VAAT and the ECG‐based PAVEL technologies would be spatially concordant in their predictions. Objective The objective is to test this hypothesis in ischemic cardiomyopathy patients in a retrospective feasibility study. Methods Four post‐infarct patients who underwent LV VT ablation and had pre‐procedural LGE‐CMRs were enrolled. Virtual hearts with patient‐specific scar and border zone identified potential VTs and ablation targets. Patient‐specific PAVEL based on a population‐derived statistical method localized VT exit sites onto a patient‐specific 238‐triangle LV endocardial surface. Results Ten induced VTs were analyzed and 9‐exit sites were localized by PAVEL onto the patient‐specific LV endocardial surface. All nine predicted VT exit sites were in the scar border zone defined by voltage mapping and spatially correlated with successful clinical lesions. There were 2.3 ± 1.9 VTs per patient in the models. All five VAAT lesions fell within regions ablated clinically. VAAT targets correlated well with 6 PAVEL‐predicted VT exit sites. The distance between the center of the predicted VT‐exit‐site triangle and nearest corresponding VAAT ablation lesion was 10.7 ± 7.3 mm. Conclusions VAAT targets are concordant with the patient‐specific PAVEL‐predicted VT exit sites. These findings support investigation into combining these two complementary technologies as a noninvasive, clinical tool for targeting clinically induced VTs and regions likely to harbor potential VTs.