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.
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This work was supported by the NIH Pioneer Award (DP1-HL123271) to N.A.T.
N.A.T. holds partial ownership of CardioSolv Ablation Technologies LLC. S.N. is a scientific advisor to CardioSolv Ablation Technologies LLC. The other authors declare no competing interests.
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary figures and tables.
Initiation of VT for patient 2 in the retrospective human study of patients with ICDs.
Initiation of sustained VT in the heart model of the patient from the prospective human study at the University of Utah.
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Prakosa, A., Arevalo, H.J., Deng, D. et al. Personalized virtual-heart technology for guiding the ablation of infarct-related ventricular tachycardia. Nat Biomed Eng 2, 732–740 (2018). https://doi.org/10.1038/s41551-018-0282-2
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