Personalized virtual-heart technology for guiding the ablation of infarct-related ventricular tachycardia

Ventricular tachycardia (VT), which can lead to sudden cardiac death, occurs frequently in patients with myocardial infarction. Catheter-based radio-frequency ablation of cardiac tissue has achieved only modest efficacy, owing to the inaccurate identification of ablation targets by current electrica...

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Published inNature biomedical engineering Vol. 2; no. 10; pp. 732 - 740
Main Authors Prakosa, Adityo, Arevalo, Hermenegild J., Deng, Dongdong, Boyle, Patrick M., Nikolov, Plamen P., Ashikaga, Hiroshi, Blauer, Joshua J. E., Ghafoori, Elyar, Park, Carolyn J., Blake, Robert C., Han, Frederick T., MacLeod, Rob S., Halperin, Henry R., Callans, David J., Ranjan, Ravi, Chrispin, Jonathan, Nazarian, Saman, Trayanova, Natalia A.
Format Journal Article
LanguageEnglish
Published London Nature Publishing Group UK 01.10.2018
Nature Publishing Group
Subjects
59/57
631/114/2413
692/4019/2776
692/4019/592/75/2/1674
692/4019/592/75/29/1938
Ablation
Biomedical and Life Sciences
Biomedical Engineering/Biotechnology
Biomedicine
Cardiac arrhythmia
Catheters
Computer applications
Electrocardiography
Feasibility studies
Heart
Mapping
Myocardial infarction
Patients
Radio frequency
Swine
Tachycardia
Target recognition
Ventricle
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Summary:Ventricular tachycardia (VT), which can lead to sudden cardiac death, occurs frequently in patients with myocardial infarction. Catheter-based radio-frequency ablation of cardiac tissue has achieved only modest efficacy, owing to the inaccurate identification of ablation targets by current electrical mapping techniques, which can lead to extensive lesions and to a prolonged, poorly tolerated procedure. Here, we show that personalized virtual-heart technology based on cardiac imaging and computational modelling can identify optimal infarct-related VT ablation targets in retrospective animal (five swine) and human studies (21 patients), as well as in a prospective feasibility study (five patients). We first assessed, using retrospective studies (one of which included a proportion of clinical images with artefacts), the capability of the technology to determine the minimum-size ablation targets for eradicating all VTs. In the prospective study, VT sites predicted by the technology were targeted directly, without relying on prior electrical mapping. The approach could improve infarct-related VT ablation guidance, where accurate identification of patient-specific optimal targets could be achieved on a personalized virtual heart before the clinical procedure. A personalized virtual-heart model that determines optimal radio-frequency ablation targets for infarct-related tachycardia is validated in retrospective large-animal and patient studies, and in a prospective study in patients.
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Author Contributions. AP, HJA, DD, HA, and PPN performed animal and human LGE-MRI scan segmentation and model creation. AP, HJA, DD and NAT designed the simulation protocols. DD, HJA, AP and PN performed simulations of VT in all models. DD, AP, PMB, HJA, and NAT analyzed the data. AP developed the pipeline for model generation from MRI scans with ICD artifact. DD and AP adapted the automatic algorithm for determining the ablation tragets in the ventricles. HH provided the swine MRI and electrophysiological data, as well as input for the animal study. SN provided part of the human MRI scans (at Johns Hopkins), conducted the prospectove studies at University of Pennsylvania, and provided clinical guidance and input. JC provided the reminder of the human MRI scans and patient outcomes. AP developed the methodology for input of simulation data into the clinical CARTO mapping system. JB, EG, RM, and RR developed and implemented the clinical protocols at the University of Utah. RR and FH recruited patients and conducted VT ablations for the prospective human study at the University of Utah. SN and DC recruited patients and conducted VT ablations for the prospective human study at the University of Pennsylvania. NAT initiated the collaborations, designed and coordinated the studies with contributions from: HJA and HH (retroprospective swine and human studies), SN and RR (prospective human studies), and AP and SN (retrospective human with ICD study), and supervised all simulation studies. HJA, DD, AP, PMB, EG, and RR generated figures, tables, and movies. NAT wrote the manuscript with input from AP and HJA. All authors discussed the results and commented on the manuscript.
ISSN:2157-846X
2157-846X
DOI:10.1038/s41551-018-0282-2