Author + information
- Received May 4, 2015
- Revision received September 22, 2015
- Accepted October 21, 2015
- Published online July 1, 2016.
- Antonio Esposito, MDa,b,∗ (, )
- Anna Palmisano, MDa,b,
- Sofia Antunes, PhDc,
- Giuseppe Maccabelli, MDd,
- Caterina Colantoni, MDa,b,
- Paola Maria Vittoria Rancoita, PhDe,
- Francesca Baratto, MDd,
- Clelia Di Serio, PhDe,
- Giovanna Rizzo, MScf,
- Francesco De Cobelli, MDa,b,
- Paolo Della Bella, MDd and
- Alessandro Del Maschio, MDa,b
- aUnit of Clinical Research in Radiology, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- bUniversità Vita-Salute San Raffaele, Milan, Italy
- cImages Post-Processing and Analysis, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- dArrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milan, Italy
- eUniversity Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
- fInstitute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Province of Milan, Italy
- ↵∗Reprint requests and correspondence:
Dr. Antonio Esposito, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Objectives This study sought to compare myocardial scars depicted by computed tomography (CT) with electrical features from electro-anatomic mapping (EAM), assessing the potential role of CT integration in ventricular tachycardia (VT) and radiofrequency catheter ablation (RFCA) procedures.
Background Imaging-based characterization of VT myocardial substrate is required to plan EAM and, potentially, to guide RFCA.
Methods Forty-two consecutive patients, 35 of whom had implantable cardioverter-defibrillator, all referred for VT RFCA, underwent pre-procedural CT including an angiographic and a 10-min delayed-enhancement scan. Segmental comparison between scars segmented from CT and low voltages (bipolar voltages <1.5 mV; unipolar voltages <8 mV), late potentials, and RF ablation points on EAM, was carried out. In a subset of 16 consecutive patients, a further point-by-point analysis was performed: a CT-derived 3-dimensional structure including heart anatomy and myocardial scars was integrated with EAM for quantitative comparison.
Results CT scans identified scars in 39 patients and defined left ventricular wall involvement and mural distribution. Overall segmental concordance between CT and EAM was good (κ = 0.536) despite the presence of implantable cardioverter-defibrillator, scar etiologies, and mural distribution. CT identified segments characterized by low voltages with good sensitivity (76%), good specificity (86%), and very high negative predictive value (95%). Late potentials and RF ablation points fell on scarred segments identified from CT in 79% and 81% of cases, respectively. Point-by-point quantitative comparison revealed good correlation between the average area of scar detected at CT and at bipolar mapping (CT = 4,901 mm2, bipolar voltages-EAM = 4,070 mm2; R = 0.78; p < 0.0001). In this study, 70% and 84% of low-amplitude bipolar points were mapped at a maximum distance of 5 mm and 10 mm from CT-segmented scar, respectively.
Conclusions CT with delayed-enhancement provides a 3-dimensional characterization of VT scar substrate together with a detailed anatomic model of the heart. This information may offer assistance to plan EAM and RFCA procedures and is potentially suitable for EAM-imaging integration.
- cardiac computed tomography
- computed tomography delayed enhancement
- electro-anatomic mapping
- radiofrequency catheter ablation
- ventricular tachycardia
This research was partially supported by a grant from the Italian Ministry of Health: “Giovani Ricercatori—Ricerca Finalizzata,” project number GR-2009-1594705. The funders had no role in this study. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dr. Maccabelli is deceased.
- Received May 4, 2015.
- Revision received September 22, 2015.
- Accepted October 21, 2015.
- 2016 American College of Cardiology Foundation