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首页> 外文期刊>European Heart Journal: The Journal of the European Society of Cardiology >Usefulness of contrast-enhanced cardiac magnetic resonance in identifying the ventricular arrhythmia substrate and the approach needed for ablation
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Usefulness of contrast-enhanced cardiac magnetic resonance in identifying the ventricular arrhythmia substrate and the approach needed for ablation

机译：对比增强的心脏磁共振在确定室性心律失常底物和消融所需方法中的有用性

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Aims: The endocardial vs. epicardial origin of ventricular arrhythmia (VA) can be inferred from detailed electrocardiogram (ECG) analysis. However, despite its clinical usefulness, ECG has limitations. Alternatively, scarred tissue sustaining VAs can be identified by contrast-enhanced cardiac magnetic resonance (ce-CMR). The objective of this study was to determine the clinical value of analysing the presence and distribution pattern of scarred tissue in the ventricles to identify the VA site of origin and the ablation approach required. Methods and results: A ce-CMR study was carried out before the index ablation procedure in a cohort of 80 patients with non-idiopathic VA. Hyper-enhancement (HE) in each ventricular segment was coded as absent, subendocardial, transmural, mid-myocardial, or epicardial. The endocardial or epicardial VA site of origin was also assigned according to the approach needed for ablation. The clinical VA was successfully ablated in 77 (96.3%) patients, all of them showing HE on ce-CMR. In segments with successful ablation of the clinical ventricular tachycardia, HE was absent in 3 (3.9%) patients, subendocardial in 19 (24.7%), transmural in 36 (46.7%), mid-myocardial in 8 (10.4%), and subepicardial in 11 (14.3%) patients. Epicardial ablation of the index VA was necessary in 3 (6.1%) ischaemic and 12 (42.9%) non-ischaemic patients. The presence of subepicardial HE in the successful ablation segment had 84.6% sensitivity and 100% specificity in predicting an epicardial origin of the VA. Conclusion: Contrast-enhanced cardiac magnetic resonance is helpful to localize the target ablation substrate of non-idiopathic VA and also to plan the approach needed, especially in non-ischaemic patients.
机译：目的：可以从详细的心电图（ECG）分析中推断出室性心律失常（VA）的心内膜和心外膜起源。但是，尽管ECG有临床用处，但还是有局限性。可替代地，可以通过对比增强的心脏磁共振（ce-CMR）来识别维持组织的VA的疤痕。这项研究的目的是确定分析心室中瘢痕组织的存在和分布模式以鉴定VA起源部位和所需消融方法的临床价值。方法和结果：在80例非特发性VA患者中，在消融术前进行了ce-CMR研究。在每个心室节段中将过度增强（HE）编码为缺失，心内膜下，透壁，心肌中层或心外膜。还根据消融所需的方法分配了心内膜或心外膜VA的起源部位。临床VA成功消融了77例（96.3％）患者，所有患者均在ce-CMR上显示HE。在成功消融临床室性心动过速的部分中，3例（3.9％）的患者不存在HE，19例（24.7％）的心内膜下，36例（46.7％）的透壁膜，8例（10.4％）的心肌中膜和11名（14.3％）患者中。在3例（6.1％）缺血性和12例（42.9％）非缺血性患者中，必须进行VA指数的心外膜消融。在成功的消融术中，心外膜下HE的存在在预测VA的心外膜起源方面具有84.6％的敏感性和100％的特异性。结论：对比增强的心脏磁共振有助于定位非特发性VA的目标消融底物，并有助于计划所需的方法，尤其是在非缺血性患者中。

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