Personalized voltage maps guided by cardiac magnetic resonance in the era of high-density mapping

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2024-10-01 DOI:10.1016/j.hrthm.2024.04.074

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Abstract

Background

Voltage mapping could identify the conducting channels potentially responsible for ventricular tachycardia (VT). Standard thresholds (0.5–1.5 mV) were established using bipolar catheters. No thresholds have been analyzed with high-density mapping catheters. In addition, channels identified by cardiac magnetic resonance (CMR) has been proven to be related with VT.

Objective

The purpose of this study was to analyze the diagnostic yield of a personalized voltage map using CMR to guide the adjustment of voltage thresholds.

Methods

All consecutive patients with scar-related VT undergoing ablation after CMR (from October 2018 to December 2020) were included. First, personalized CMR-guided voltage thresholds were defined systematically according to the distribution of the scar and channels. Second, to validate these new thresholds, a comparison with standard thresholds (0.5–1.5 mV) was performed. Tissue characteristics of areas identified as deceleration zones (DZs) were recorded for each pair of thresholds. In addition, the relation of VT circuits with voltage channels was analyzed for both maps.

Results

Thirty-two patients were included [mean age 66.6 ± 11.2 years; 25 (78.1%) ischemic cardiomyopathy]. Overall, 52 DZs were observed: 44.2% were identified as border zone tissue with standard cutoffs vs 75.0% using personalized voltage thresholds (P = .003). Of the 31 VT isthmuses detected, only 35.5% correlated with a voltage channel with standard thresholds vs 74.2% using adjusted thresholds (P = .005). Adjusted cutoff bipolar voltages that better matched CMR images were 0.51 ± 0.32 and 1.79 ± 0.71 mV with high interindividual variability (from 0.14–1.68 to 0.7–3.21 mV).

Conclusion

Personalized voltage CMR-guided personalized voltage maps enable a better identification of the substrate with a higher correlation with both DZs and VT isthmuses than do conventional voltage maps using fixed thresholds.

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高密度绘图时代以心脏磁共振为指导的个性化电压图

背景电压测图可确定可能导致室性心动过速（VT）的传导通道。使用双极导管确定了标准阈值（0.5-1.5 mV）。尚未对高密度绘图导管的阈值进行分析。此外，心脏磁共振（CMR）确定的通道已被证明与 VT 有关。本研究旨在分析使用 CMR 指导调整电压阈值的个性化电压图的诊断率。方法纳入所有经 CMR（2018 年 10 月至 2020 年 12 月）消融的瘢痕相关 VT 连续患者。首先，根据瘢痕和通道的分布系统地定义了 CMR 指导下的个性化电压阈值。其次，为了验证这些新阈值，与标准阈值（0.5-1.5 mV）进行了比较。每对阈值都记录了被确定为减速区（DZ）的区域的组织特征。此外，还分析了两种图谱的 VT 电路与电压通道的关系。结果32 例患者被纳入研究[平均年龄 66.6 ± 11.2 岁；25 例（78.1%）缺血性心肌病]。共观察到 52 个 DZ：使用标准临界值时，44.2% 被识别为边界区组织；使用个性化电压临界值时，75.0% 被识别为边界区组织（P = .003）。在检测到的 31 个 VT 峡部中，使用标准阈值时只有 35.5% 与电压通道相关，而使用调整阈值时则为 74.2%（P = .005）。结论与使用固定阈值的传统电压图相比，CMR 引导的个性化电压图能更好地识别基底，与 DZ 和 VT 峡部的相关性更高。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.