Imaging Based Computational Modeling Guided Ablation of Cardiac Arrhythmias

Ravi Ranjan
University of Utah


Abstract

Cardiac arrhythmias are a common occurrence. Many of them are re-entrant and they sustain around areas of scar. Ablation is a major treatment strategy used for these arrhythmias. Ablating them requires mapping these arrhythmias but that can be limited for numerous reasons. One, the best map is made during the arrhythmia but areas of low voltage present in areas of scar can make it challenging to determine the exact time of local activation. Ambiguity in this local activation time determination can make the maps inaccurate. Two, most of the time the scar is determined as these maps are made based on low voltage of the local bipolar electrogram. This can be time consuming and can be affected by poor catheter contact to the chamber wall. Three, for certain arrhythmias there can be more than just the presenting arrhythmia. To determine the circuit each one of them needs to be mapped during the arrhythmia. This can be challenging as such latent arrhythmias might not be readily inducible and can present at a later time reducing the overall success of these procedures. Imaging guided ablation using computational modelling can address some of these issues and provides an exciting avenue to overcome some of these challenges. Late gadolinium enhancement MRI can provide scar information in the cardiac chambers. This scar information can be used to make computational model and carry out a virtual electrophysiology study. The virtual electrophysiology allows to induce and see the circuit of all the arrhythmias including the latent arrhythmias. Moreover, the virtual electrophysiology study allows to test different ablation strategies to make sure all re-entrant arrhythmias are non-inducible. Clearly, these will need to be tested in prospective studies to establish the utility of this strategy in treating arrhythmias.