SIMPÓSIO SOBRAC-EHRA - TAQUICARDIA VENTRICULAR I

23/11/2019 – 11:0-12:00

Cristiano Pisani

Unidade de Arritmia do InCor/HC/FMUSP

Imaging the Scar in Ventricular Tachycardia -The use of ADAS software

SIMPÓSIO SOBRAC-EHRA - TAQUICARDIA VENTRICULAR III

23/11/2019 – 11:0-12:00

Imaging the Scar in Ventricular Tachycardia -The use of ADAS software

Conflito de Interesse: Cristiano Pisani - Palestrante em eventos ou atividades patrocinadas pela indústria – Biosense-Webster

Cardiac MRI – LGE

• Gadolinium Infusion 10-15 min for contrast to

redistribute into the scarred/edematous regions

Gadolinium shortens T1 where it is concentrated

Kim, Circulation. 1999;100:1992-2002

“Bright is dead”

Cardiac MRI on Ventricular Tachycardia

• Cardiac MRI

• Risk Stratification

• VT ablation

• Ablation Circuit Prediction

• Channels Identification

• Transmurality

• Epicardial/Endocardial Scar

• Epicardial Fat

Risk Stratification – Chagas Disease

Tiago Senra, Carlos Rochitte. J Am Coll Cardiol 2018;72:2577–87

VT Inducible VT non-Inducible

Cardiac Magnetic Ressonance

Halperin, HR 2013

ADAS Automatic Detection of Arrhythmia Substrate

Spears, Heart Rhythm 2012;9:1837–1846

Cardiac MRI – Substrate Identification

J Am Coll Cardiol Img 2014;7:774–84

Armenta, Brugada. Circ Arrhythm Electrophysiol. 2013;6:528-537.)

Channel Identification

#6

#1

#3

VT#2VT#1- Clinical VT#3

#2 #4

1

4

4

21

1

3

2

1

13

CristianoPisani,ThaisPinheiro Lima,CarinaHardy,SissyLara,FranciscoDarrieux,DeniseHachul,JoseRobertoParga,CarlosRochitte,MauricioScanavacca

HeartInstitute,UniversityofSãoPauloMedicalSchool,SãoPaulo,Brazil

AnalysisofVTSubstrateinChagasDiseasePatientsUsing3D-LGEMRIandAutomaticDetectionArrhythmiaSubstrate(ADAS)software.

HRS 2017

ADAS Analysis N=6

Maximum Pixel Signal Intensity, % 36.5±9.5

Minimum Pixel Signal Intensity, % 41±5.7%

Channels Detected per patient, median (Q1;Q3)

3.5 (2.5; 7.75)

Left Ventricule mass, grams 169±40

Scar mass, grams 45±19Proportion of Scar, % 27±14

Core, % 6±4Border Zone, % 20±10

MRI Image Integration

Heart Rhythm. 2017 Aug;14(8):1121-1128

Cardiac MRI

• Limitations

• Motion Effects

• Adequate technique – time to gadolinium redistribution

• Artifacts from ICD

• Nephrogenic Systemic Fibrosis

• Rare

• Not Reversible

• Gadolinium

• Contraindicated if GFR < 30, Not recommended GFR 30-60

• 2D Channel identification

Cardiac MRI

• Current use of MRI

• Pre ablation definition of strategy – Epi/Endo

• Shorter ablation procedures

• Better Efficacy with imaging integration

• All channel identification

• Future Perspectives

• Different Software – Carto Native Image Processing Software (V8)

• Imaging Ablated Ventricular Tissue

• MRI Themography

• Detection of Gaps

• Virtual EP study