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M. Takigawa, *. Md, M. D. Duchateau, F. Sacher, M. D. Martin et al.,

G. Massoullie, F. Md, M. D. Bourier, A. Lam, M. D. Wolf et al., Of 3163 (2493-5960) mapping points in SR, 382 (191-1115) local abnormal ventricular activities (LAVAs) were identified. One patient had a maximal proportion of LAVAs in 3-4 mm, 3 patients in 2-3 mm, 2 in 1-2 mm, and 2 in 0-1 mm. The VT isthmuses of all 10 VTs corresponded with 1-4 CT channels. Twenty-one of the 41 CT channels (51.2%) corresponded to a VT isthmus (entrance, mid, or exit). Electrophysiological VT isthmuses were more likely to be associated with CT channels that were longer

, CONCLUSION VT isthmuses were always found in CT channels (100% sensitivity), and half of CT channels hosted VT isthmuses (positive predictive value 51%). Longer and thinner (but .1 mm) CT channels were significantly associated with VT isthmuses, KEYWORDS Contrast-enhanced multidetector computed tomography

, High-resolution mapping; Isthmus; MUSIC; Myocardial infarction; Ventricular tachycardia, Heart Rhythm Society, vol.16, pp.1661-1668, 2019.

, All rights reserved

B. Desjardins, T. Crawford, and E. Good, Infarct architecture and characteristics on delayed enhanced magnetic resonance imaging and electroanatomic mapping in patients with postinfarction ventricular arrhythmia, Heart Rhythm, vol.6, pp.644-651, 2009.

A. P. Wijnmaalen, R. J. Van-der-geest, and C. F. Van-huls-van-taxis, Head-to-head comparison of contrast-enhanced magnetic resonance imaging and electroanatomical voltage mapping to assess post-infarct scar characteristics in patients with ventricular tachycardias: real-time image integration and reversed registration, Eur Heart J, vol.32, pp.104-114, 2011.

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O. Mesubi, G. Ahmad, and J. Jeudy, Impact of ICD artifact burden on late gadolinium enhancement cardiac MR imaging in patients undergoing ventricular tachycardia ablation, Pacing Clin Electrophysiol, vol.37, pp.1274-1283, 2014.

B. L. Gerber, B. Belge, and G. J. Legros, Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: comparison with contrast-enhanced magnetic resonance, Circulation, vol.113, pp.823-833, 2006.

R. E. Kanza, H. Higashino, and T. Kido, Quantitative assessment of regional left ventricular wall thinning and thickening using 16 multidetector row computed tomography: comparison with cine magnetic resonance imaging, Radiat Med, vol.25, pp.119-126, 2007.

J. Tian, J. Jeudy, and M. F. Smith, Three-dimensional contrast-enhanced multidetector CT for anatomic, dynamic, and perfusion characterization of abnormal myocardium to guide ventricular tachycardia ablations, Circ Arrhythm Electrophysiol, vol.3, pp.496-504, 2010.

Y. Komatsu, H. Cochet, and A. Jadidi, Regional myocardial wall thinning at multidetector computed tomography correlates to arrhythmogenic substrate in postinfarction ventricular tachycardia: Assessment of structural and electrical substrate, Circ Arrhythm Electrophysiol, vol.6, pp.342-350, 2013.
URL : https://hal.archives-ouvertes.fr/hal-00855932

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URL : https://hal.archives-ouvertes.fr/hal-00813820

S. Yamashita, F. Sacher, and S. Mahida, The role of high-resolution image integration to visualize left phrenic nerve and coronary arteries during epicardal ventricular tachycardia ablation, Circ Arrhythm Electrophysiol, vol.8, pp.371-380, 2015.

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, Ablation of CT-derived wall thickness channels in post-infarction ventricular tachycardia: 1939 comparison to conventional LAVA elimination strategy

, Background and purpose

, From the result of the second study (Chapter 6-2), we have proved that the CT-derived channels are associated with 1943

. Vt-isthmuses, Based on these facts, we 1945 hypothesized that CT-derived wall thickness channels ablation strategy may be more specifically target the potential 1946 VT isthmuses and may shorten the procedure time with a similar outcome from the conventional LAVA elimination 1947 strategy in ischemic VT. The endpoint of CT-channel ablation is loss of local capture on the CT-channels

, Methods and results

, Of 214 consecutive patients received CA for ischemic VT between, vol.25, p.1952, 2010.

, CT-channel based ablation strategy. 25 patients treated with LAVA elimination were matched in a 1:1 ratio based on 1953 propensity scores with similar characteristics (age, gender, LVEF, risk factors, therapies, arrhythmia burden, catheter 1954 mapping techniques), which resulted in two balanced groups of 25 patients each. Outcome, procedure time, 1955.

, CT-ablation reduced the median 1964 procedure time by 25%. Complication rate was similar between the two groups (one cardiac tamponade in LAVA-1965 ablation group, and one stroke in CT-ablation group, pp.6-9, 1963.

, Table 6-3. Comparison of Procedural characteristic and acute results, 1968.

, VT-recurrence at 1 year was observed in 5/25 (20.0%) in the LAVA-ablation group and 6/25 (24.0%) in the CT-1970 ablation group (P=1.0000). VT-recurrence free survival rate was similar between the two group

, Figure 6-3-2. Follow-up after the VT-ablation, 19751976.

, Complete LAVA elimination was frequently not achieved in the CT-ablation group, but post-ablation VT 1978 inducibility and VT-recurrence rate at 1 year were similar between two groups. Substrate-based ablation targeting, 1979.

, CT-defined channels shortens VT ablation procedures by over 20% with similar outcomes as compared to the 1980 conventional strategy targeting the electrophysiological substrate

, Ablation of CT-derived wall thickness channels in post-infarction ventricular tachycardia: comparison to 1986 conventional LAVA elimination strategy

M. Takigawa, J. Duchateau, F. Sacher, R. Martin, K. Vlachos et al., , 1988.

A. Frontera, N. Thompson, C. Martin, G. Massoullie, F. Bourier et al., , 1989.

A. Denis, N. Derval, M. Hocini, M. Haissaguerre, H. Cochet et al.,

, Throughout the thesis, I have described the current developments in mapping techniques and modalities. I have 2017 especially focused on the impact of high-resolution/high-density mapping systems, novel multipolar catheters, and 2018 image information for clinical use

, using an infarcted animal model, it is demonstrated that EGMs are strongly influenced by interelectrode 2020 spacing, activation orientation, and electrode sizes. Therefore, these factors should significantly affect the substrate 2021 distributions. The substrate of interest may be changed by these elements, p.2022

, If the inter-electrode 2023 spacing is too large, then bipolar electrodes may miss the subendocardial substrates because of a far-field effect. The 2024 relationship between the activation front and the bipolar orientation may mask or unmask the substrates. Because it 2025 becomes more difficult to manually validate and annotate all EGMs in the era of high-density mapping, then bipolar electrodes may miss the intramural substrate, which may be away from the catheter

, With this new mapping 2029 tool, which generally has higher density and higher resolution compared to conventional mapping systems, the AT 2030 mechanism and accurate circuit of the tachycardia can be displayed more easily and clearly. Very few studies 2031 discussing the mechanism of scar-related ATs have been published in the past 5 years. We have not been able to 2032 observe the mechanism of scar-related ATs in detail because of the lower resolution of the mapping system and 2033 catheters, Rhythmia TM , is demonstrated

, Even if the mechanism and 2036 circuit of ATs are correctly diagnosed with the high-resolution mapping system, the clinical outcomes may not be 2037 improved if the catheter technology is not optimal. Lesions may be influenced by multiple factors such as electrode 2038 size, contact direction, contact force, RF duration, RF power, stability, and tissue characteristics. Recent catheters 2039 have a formula to unite these parameters and objectively assess the lesion 104-107 . The impact of this technology should 2040 be elucidated. New power sources 108-111 may dramatically change ablation outcomes, However, for better outcomes of AT ablation, not only a mapping system but also catheter technology to create 2035 durable and transmural lesions should be discussed

, In chapter 6, the relationship between wall thickness distribution on CT imaging and substrate mapping using the 3D

, It was also demonstrated that CT channel ablation may provide similar safety 2044 and outcomes compared to LAVA ablation. The use of preprocedural imaging has several advantages, and image 2045 information registered on the 3D EAM may strongly support the ablation procedure, EAM for ICM patients was described, p.2046

, A novel wideband LGE-MRI 2047 technique seems promising for device artifact removal in ICD patients, with its efficacy depending on the distance 2048 from the device to the LV 112 . Late iodine-enhanced multidetector CT has the potential to improve scar, 3D rotational angiography could also be helpful for improving the merging of images, p.2049

, ischemic VT patients with ICDs in whom LGE-MRI is still considered strongly contraindicated 113,114 . Learning using 8. References, 20551.

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