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Improved Multi-modality Data Fusion of Late Gadolinium Enhancement MRI to Left Ventricular Voltage Maps In Ventricular Tachycardia Ablation

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Roujol S, Basha TA, Tan A, Khanna V, Chan RH, Moghari MH, Rayatzadeh H, Shaw JL, Josephson ME, Nezafat R
Volume: 60, Issue: 5, Page(s): 1308 – 1317

May 2013 story 3

Sudden cardiac death is the leading cause of death in developed countries. In the majority of these cases, it is caused by a heart rhythm disorder known as ventricular arrhythmia. Identification and ablation of cardiac tissues responsible for the arrhythmia (arrhythmogenic substrate) can reduce the recurrence of ventricular arrhythmia. Invasive catheter mapping of the heart is commonly used to identify the arrthythmogenic substrate by acquiring spatially-localized voltage maps using dedicated electroanatomical mapping systems. However, current substrate mapping techniques are invasive and have several limitations, which contribute to low efficacy of ablation therapy for treatment of ventricular arrhythmia. Therefore, alternative strategies to identify the arrhythmogenic substrate are desirable.

Currently, myocardial scar imaging using magnetic resonance imaging (MRI) shows significant promise for arrhythmogenic substrate identification, but it is not yet known if any specific characteristic of MRI data can be used to localize these substrates and guide the ablation procedure. To investigate the potential of MRI, accurate fusion of MRI data with voltage maps is required.

In this study, a novel automatic fusion approach is proposed using both the overall heart geometry and tissue characteristics. In particular, pathological tissues can be characterized by specific electrical properties in the voltage maps, as well as certain intensity values in MRI data. The proposed method finds the optimal geometric transformation (3D translation + 3D rotation) that matches both the heart geometry and tissue characteristics. This method is shown to be superior to conventional fusion approaches which only rely on the heart geometry.

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