Computational Re-Entry Vulnerability Index Mapping to Guide Ablation in Patients With Postmyocardial Infarction Ventricular Tachycardia

Computational Re-Entry Vulnerability Index Mapping to Guide Ablation in Patients With Postmyocardial Infarction Ventricular Tachycardia

Jelvehgaran Esfahani, M. (TU Delft Medical Instruments & Bio-Inspired Technology; Universiteit van Amsterdam)
O'Hara, Ryan (Johns Hopkins University)
Prakosa, Adityo (Johns Hopkins University)
Chrispin, Jonathan (Johns Hopkins Medical Institutions,)
Boink, Gerard J.J. (Universiteit van Amsterdam)
Trayanova, Natalia (Johns Hopkins University)
Coronel, Ruben (Universiteit van Amsterdam; Fondation Bordeaux Université)
Oostendorp, Thom (Radboud University Medical Center)

2023

Background: Ventricular tachycardias (VTs) in patients with myocardial infarction (MI) are often treated with catheter ablation. However, the VT induction during this procedure does not always identify all of the relevant activation pathways or may not be possible or tolerated. The re-entry vulnerability index (RVI) quantifies regional activation-repolarization differences and can detect multiple regions susceptible to re-entry without the need to induce the arrhythmia. Objectives: This study aimed to further develop and validate the RVI mapping in patient-specific computational models of post-MI VTs. Methods: Cardiac magnetic resonance imaging data from 4 patients with post-MI VTs were used to induce VTs in a computational electrophysiological model by pacing. The RVI map of a premature beat in each patient model was used to guide virtual ablations. We compared our results with those of clinical ablation in the same patients. Results: Single-site virtual RVI-guided ablation prevented VT induction in 3 of 9 cases. Multisite virtual ablations guided by RVI mapping successfully prevented re-entry in all cases (9 of 9). Overall, virtual ablation required 15-fold fewer ablation sites (235.5 ± 97.4 vs 17.0 ± 6.8) and 2-fold less ablation volume (5.34 ± 1.79 mL vs 2.11 ± 0.65 mL) than the clinical ablation. Conclusions: RVI mapping allows localization of multiple regions susceptible to re-entry and may help guide VT ablation. RVI mapping does not require the induction of arrhythmia and may result in less ablated myocardial volumes with fewer ablation sites.

myocardial infarction
patient-specific models
radiofrequency ablation
re-entry, re-entry vulnerability index
ventricular tachycardia

http://resolver.tudelft.nl/uuid:ee6a6487-6f0b-4590-aef7-dec8c793d0ed

https://doi.org/10.1016/j.jacep.2022.10.002

2405-500X

JACC: Clinical Electrophysiology, 9 (3), 301-310

Institutional Repository

journal article

© 2023 M. Jelvehgaran Esfahani, Ryan O'Hara, Adityo Prakosa, Jonathan Chrispin, Gerard J.J. Boink, Natalia Trayanova, Ruben Coronel, Thom Oostendorp