Cardiac Magnetic Resonance-Guided Ventricular Tachycardia Substrate Ablation.

Soto-Iglesias D ; Penela D ; Jáuregui B ; Acosta J ; Fernández-Armenta J ; Linhart M ; Zucchelli G ; Syrovnev V ; Zaraket F ; Terés C ; Perea RJ ; Prat-González S ; Doltra A ; Ortiz-Pérez JT ; Bosch X ; Camara O ; Berruezo A

Resumen: 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 noninducibility rate and lower VT recurrence after substrate ablation.

Idioma: Inglés

DOI: 10.1016/j.jacep.2019.11.004

Año: 2020

Publicado en: JACC: Clinical Electrophysiology 6, 4 (2020), 436 - 447
ISSN: 2405-500X

Factor impacto JCR: 6.375 (2020)

Categ. JCR: CARDIAC & CARDIOVASCULAR SYSTEMS rank: 26 / 141 = 0.184 (2020) - Q1 - T1

Factor impacto SCIMAGO: 2.278 - Physiology (medical) (Q1) - Cardiology and Cardiovascular Medicine (Q1)

Financiación: info:eu-repo/grantAgreement/ES/MINECO/RTC-2015-3515-1
Financiación: info:eu-repo/grantAgreement/ES/MINECO/RTC-2016-5445-1

Tipo y forma: Artículo (PostPrint)