P5691Independent assessment if an image-processing service for the treatment of patients with ventricular tachycardias
Authors: Spies F , Kuhne M , Brantner P , Haaf P , Zeljkovic I , Madaffari A , Reichlin T , Osswald S , Sticherling C , Knecht S 
Published: October 2019

Abstract

Background/Introduction
Substrate-based radiofrequency ablation (RFA) in combination with pre-procedural computed tomography (CT) or cardiac Magnetic Resonance Imaging (cMRI) emerged as a promising approach to treat ventricular tachycardias (VT). However, image-processing and 3D reconstruction of the relevant structures to embed them into a 3D electroanatomical mapping (EAM) system is time consuming and requires highly experienced personal and a dedicated software.

Purpose
The aim of the study was to present the first independent experience with a commercially available service of a internet platform in patients referred for RFA of VTs.

Methods
Seven consecutive patients (pts) with ischemic cardiomyopathy (ICM), non- ischemic cardiomyopathy (NICM) and dilated cardiomyopathy (DCM) referred for VT RFA underwent contrast-enhanced dual-energy CT. The anonymized DICOM dataset was uploaded to the internet platform. After processing by the specialists, the dataset was downloaded and exported in a format compatible with the 3D EAM System. The EAM was performed in sinus rhythm using a 3.5mm open-irrigated tip catheter or a magnetic remote 3.5mm open-irrigated tip catheter in combination with the remote magnetic navigation-system. A multipolar high-density mapping catheter was used in 6 pts. Scar was defined as bipolar voltage <0.5 mV, and scar border zone ≥0.5mV and <1.5 mV.
Results of the internet platform-derived wall thinning (WT), scars and the defined substrate based on 3d EAM voltage maps were transferred into a 17-segment model, and the filling of every single segment was rated as 0%, 25%, 50%, 75% and 100%. For analysis, agreement of the filling (percentage) of the individual segments was quantified.

Results
Mean age was 67±8 year, BMI was 28±5 kg/m2 and 86% were males. File transfers and image processing was feasible in all patients. Agreement between the defined substrate (<0,5mV) and WT of 4mm was very good (≥90%) in 3 pts, good (≥75% & <90%) in one patient, moderate (≥50% & <75%) in one patient and poor (<50%) in one patient.
Patient #1 #2 #3 #4 #5 #6 #7 Sex male male male female male male male Age 63y 56y 71y 65y 60y 69y 81y BMI 31kg/m2 32kg/m2 19kg/m2 25kg/m2 28kg/m2 34kg/m2 29kg/m2 LVEF 25% 60% 25% 25% 25% 31% 34% EDVI 123ml/m2 184ml/m2 69ml/m2 114ml/m2 142ml/m2 105ml/m2 75ml/m2 Catheter multipolar high-density + 3.5mm open-irrigated tip 3.5mm open-irrigated tip multipolar high-density + 3.5mm open-irrigated tip multipolar high-density + 3.5mm open-irrigated tip multipolar high-density + magnetic remote 3.5mm open-irrigated tip multipolar high-density + magnetic remote 3.5mm open-irrigated tip multipolar high-density + magnetic remote 3.5mm open-irrigated tip Quality 98% 96% 91% 66% 89% no match 53% Quality = Percentage match between defined substrate and WT.
Superimpose – wall thinning and FAM

Conclusion(s)
Integration of substrate-based segmentation using the service of the internet platform is feasible in daily practice. Agreement between voltage-map based substrate definition and internet platform-based WT was satisfactory in the majority of patients.