In patients with ischemic cardiomyopathy (ICM), ventricular remodeling can create slow-conduction channels and critical isthmuses that may participate in reentrant ventricular tachycardia (VT) circuits. This case, discussed with Vincent Pannetier, Production Manager at inHEART, illustrate show patient-specific cardiac modeling can bring together complementary imaging information to characterize this substrate and support ventricular tachycardia ablation planning
From multimodality imaging to a patient-specific model
The patient had a history of ischemic cardiomyopathy, coronary artery bypass graft, circumflex artery stents, and anICD. Both arterial-phase cardiac CT and LGE-MRI were available for analysis.However, image quality was hampered by limited contrast opacification in the right cardiac chambers, ICD lead artifacts, and a high noise level in CT.
Despite these limitations, inHEART was able to generate a detailed left ventricular model providing relevant clinical information on the arrhythmogenic substrate including wall thinning, subendocardial fatty infiltration, myocardial calcifications, and transmural scar distribution. The left phrenic nerve was also clearly identified allowing assessment of the potential risk of phrenic nerve injury.
Vincent explained that CT provided detailed anatomical information and enabled characterization of structural remodeling, while LGE-MRI added complementary tissue characterization and scar assessment.These features can frequently coexist within the same myocardial region, but each provides distinct and relevant clinical information. Combining these findings within a patient-specific 3D model provides a more comprehensive representation of the substrate that physicians can consider when planning the ablation strategy.
When asked how physicians can use this 3D model for preprocedural planning, Vincent explained that CT-based analysis can help identify potential conducting channels which can then be visualized and annotated within the inHEART platform, as shown in the video below.
