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Open Access Changing the Way We “See” Scar: How Multimodality Imaging Fits in the Electrophysiology Laboratory

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Substrate characterization is the mainstay of ablation for ventricular tachycardia (VT). Although the use of electroanatomic voltage mapping (EAVM) in the electrophysiology (EP) laboratory has enabled real-time approximation of myocardial scar, it has limitations. This is related to the subjective and tedious nature of voltage mapping and the challenges of defining the transmurality of scar. Various noninvasive methods of scar assessment have emerged, with magnetic resonance imaging (MRI) being the most accurate. Integrated MRI and electroanatomic voltage mapping studies demonstrate good correlation. Nonetheless, MRI has advantages. These include (1) preprocedure identification of epicardial and intramural scar, (2) assessment of ablative lesion formation after unsuccessful ablations, (3) identification of heterogeneous regions of scar, where critical conducting channels are likely to occur, and (4) predictive value in the assessment of sudden cardiac death (SCD). Integration of scar imaging in ventricular tachycardia ablation and risk stratification has great potential to advance the practice of arrhythmia management.

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Keywords: ablation; electroanatomic voltage mapping; late gadolinium enhancement; magnetic resonance imaging; myocardial scar; substrate; sudden cardiac death; ventricular tachycardia

Document Type: Research Article

Publication date: February 1, 2016

More about this publication?
  • Cardiovascular Innovations and Applications (CVIA) publishes focused articles and original clinical research that explore novel developments in cardiovascular disease, effective control and rehabilitation in cardiovascular disease, and promote cardiovascular innovations and applications for the betterment of public health globally. The journal publishes basic research that has clinical applicability in order to promote timely communication of the latest insights relating to coronary artery disease, heart failure, hypertension, cardiac arrhythmia, prevention of cardiovascular disease with a heavy emphasis on risk factor modification. Cardiovascular Innovations and Applications is the official journal of the Great Wall International Congress of Cardiology (GW-ICC). It aims to continue the work of the GW-ICC by providing a global scientific communication platform for cardiologists that bridges East and West.

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