Mapping the transmural scar and activation for patients with ventricular arrhythmia

Myocardial scar is the most common substrate for malignant arrhythmia and cardiac arrest. Radiofrequency ablation, as one of the emerging mainstream therapies, currently relies on electrophysiologic (EP) map acquired on endocardial and occasionally epicardial surfaces. As myocardial scar is often complex with shapes varying with the depth of the myocardium, endocardial and epicardial maps may differ substantially, and may fail to identify mid-wall fibrosis that exist in ∼ 30% of patients with nonischemic cardiomyopathy. Alternative image-based delineation of anatomical scar is noninvasive and transmural, but it does not reflect the possibly EP functional anomaly. In this paper, we present a validation study of a previously developed method that combines body-surface electrocardiographic data and image-derived anatomic data to compute EP and scar details along the depth of the myocardium. Experiments were performed on 4 patients referred for ablation associated with myocardial infarction, with gold standards of substrate voltage maps and activation maps acquired by CARTO electroanatomic mapping system. This study exhibits the ability of the presented method in accurately quantifying the scar substrate and capturing abnormal EP patterns, not only on the heart surfaces but along the transmural dimension.