Evaluation of left ventricular scar identification from contrast enhanced magnetic resonance imaging for guidance of ventricular catheter ablation therapy

Patients with ventricular arrhythmias typically exhibit myocardial scarring, which is believed to be an important anatomic substrate for reentrant circuits, thereby making these regions a key target in catheter ablation therapy. In ablation therapy, a catheter is guided into the left ventricle and radiofrequency energy is delivered into the tissue to interrupt arrhythmic electrical pathways. Low bipolar voltage regions are typically localized during the procedure through point-by-point construction of an electroanatomic map by sampling the endocardial surface with the ablation catheter and are used as a surrogate for myocardial scar. This process is time consuming, requires significant skill, and has the potential to miss low voltage sites. This has led to efforts to quantify myocardial scar preoperatively using delayed, contrast-enhanced MRI. In this paper, we evaluate the utility of left ventricular scar identification from delayed contrast enhanced magnetic resonance imaging for guidance of catheter ablation of ventricular arrhythmias. Myocardial infarcts were created in three canines followed by a delayed, contrast enhanced MRI scan and electroanatomic mapping. The left ventricle and myocardial scar is segmented from preoperative MRI images and sampled points from the procedural electroanatomical map are registered to the segmented endocardial surface. Sampled points with low bipolar voltage points visually align with the segmented scar regions. This work demonstrates the potential utility of using preoperative delayed, enhanced MRI to identify myocardial scarring for guidance of ventricular catheter ablation therapy.