Background: Implantable cardiac defibrillator (ICD) implantation can protect against sudden cardiac death (SCD) after a myocardial infarction. However, improved risk stratification for device requirement is still needed.
Objective: To improve assessment of post-infarct ventricular electro-pathology and prediction of appropriate ICD therapy by combining late gadolinium enhancement (LGE) and advanced computational modelling.
Methods: ADAS LV and custom-made software was used to generate 3D patient-specific ventricular models in a prospective cohort of post-infarct patients (n=40) having undergone LGE imaging pre-ICD implantation. Corridor metrics and 3D surface features were computed from LGE images. The Virtual Induction and Treatment of Arrhythmias (VITA) framework was applied to patient-specific models to comprehensively probe the vulnerability of the scar substrate to sustaining reentrant circuits. Imaging and VITA metrics, related to the numbers of induced VTs and their corresponding round trip times (RTTs), were compared with ICD therapy during follow-up.
Results: Patients with an event (n=17) had a larger interface between healthy-scar and higher VITA metrics. Cox-regression demonstrated a significant independent association with an event: interface (HR 2.79; 1.44-5.44, p < .01), unique VTs (HR 1.67; CI 1.04-2.68, p = .03), mean RTT (HR 2.14; CI 1.11-4.12, p = .02), maximum RTT (HR 2.13; CI 1.19-3.81, p = .01).
Conclusion: Detailed quantitative analysis of LGE based scarmaps, combined with advanced computational modeling, is able to accurately predict ICD therapy and could facilitate early identification of high-risk patients in addition to LVEF.
Keywords: ischemic cardiomyopathy; late gadolinium enhancement; ventricular tachycardia..
Copyright © 2024. Published by Elsevier Inc.