simpÓsio sobrac-ehra - taquicardia ventricular i · 2019. 12. 19. · simpÓsio sobrac-ehra -...
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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