Electrical and anatomical imaging of arrhythmogenic substrates for scar-related ventricular tachycardia

Sustained ventricular tachycardia (VT) often involves a reentry circuit formed by narrow channels of surviving tissue within the scar. Catheter ablation is an effective technique to intercept the circuit by targeting these critical channels. The success of VT ablation relies on our ability to assess the mechanism of the VT circuit and identify the location of the ablation targets. This study aims to analyze the VT substrate using high-resolution anatomical and electrical imaging techniques including contact EGM mapping, contrast-enhanced cardiac magnetic resonance (CMR) imaging, and noninvasive electrocardiographic (ECG) imaging. The results indicate that joint electro-anatomical analysis could reveal critical isthmus of the VT circuit. In addition, ECG-imaging was able to identify sites of a scar and signal fractionation visually consistent with the other two modalities, and the reconstructed VT circuit revealed an exit around the critical site identified by combined CMR-EGM data.