Abstract
ABSTRACT:
Geometrical structure of the myocardium plays an important role in understanding the generation of
arrhythmias. In particular, a heterogeneous tissue (HT) channel defined in cardiovascular magnetic
resonance (CMR) has been suggested to correlate with conduction channels defined in electroanatomic
mapping in ventricular tachycardia (VT). Despite the potential of CMR for characterization of the
arrhythmogenic substrate, there is currently no standard approach to identify potential conduction
channels. Therefore, we sought to develop a workflow to identify HT channel based on the structural
3D modeling of the viable myocardium within areas of dense scar. We focus on macro-level HT channel
detection in this work. The proposed technique was tested in high-resolution ex-vivo CMR images in 20
post-infarct swine models who underwent an electrophysiology study for VT inducibility. HT channel
was detected in 15 animals with inducible VT, whereas it was only detected in 1 out of 5 animal with
non-inducible VT (P < 0.01, Fisher’s exact test). The HT channel detected in the non-inducible animal
was shorter than those detected in animals with inducible VTs (inducible-VT animals: 35 ± 14 mm vs.
non-inducible VT animal: 9.94 mm). Electrophysiology study and histopathological analyses validated
the detected HT channels. The proposed technique may provide new insights for understanding the
macro-level VT mechanism.