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MRI Characterization of Arrhythmogenic Scar in Ventricular Tachycardia


? DESCRIPTION (provided by applicant): Sudden cardiac death (SCD) accounts for 20% of all deaths in the western world and is usually due to malignant ventricular tachycardia and fibrillation (VT/VF). There is currently no non-invasive method to assess risk of future VT. Ventricular arrhythmias usually occur due to scar tissue that borders with surviving myocardial muscle in an area designated as the arrhythmogenic scar zone to distinguish it from non-arrhythmogenic scar that does not give rise to arrhythmias. Arrhythmogenic scar has a unique structural and electrical signature that has been established in ex-vivo human specimens from patients undergoing heart transplant. However, in-vivo techniques to identify arrhythmogenic scar are limited. Invasive electrophysiological (EP) signal recordings using catheter mapping has been used for identifying patient at risk of developing malignant arrhythmia. However due to low resolution of mapping catheter, long and high risk invasive procedure, and low sensitivity and specificity, it is not clinically used to distinguish arrhythmogenic from non-arrhythmogenic scar tissue. The overall aim of this study is to non-invasively identify arrhythmogenic scar tissue using MRI by exploiting two novel technologies 1) very high-resolution scar imaging using MRI and 2) high-resolution catheter mapping. We hypothesize that the area of normal myocardium surrounded by dense scar region in 3D high-resolution scar MRI is a hallmark of arrhythmogenic scar tissue in a swine model of infarct related VT.

Funded by the NIH National Center for Advancing Translational Sciences through its Clinical and Translational Science Awards Program, grant number UL1TR002541.