Imaging surrogate of the ventricular arrhythmia substrate in a swine model of ventricular tachycardia: high resolution LGE vs. high resolution electro-anatomical mapping

Background Assessment of risk of sudden cardiac death (SCD) due to ventricular tachycardia and fibrillation (VT/VF) remains one of the most challenging areas in management of patients with chronic myocardial infarction. VT substrate consists of reentry circuits near or within a chronic scar. Invasive catheter mapping using electroanatomical system (EAM) is the clinical standard for identification of reentry circuits. However, current EAM systems have low spatial resolution which may contribute to the high recurrence rate of VT after ablation (50% at 2 years). Better identification of reentry circuits can potentially improve SCD risk assessment and outcome of VT ablation procedures. Late gadolinium enhancement (LGE) CMR has the potential for noninvasive identification of reentry circuits, but LGE sequences suffer from low spatial resolution and partial voluming (1). In this study, we sought to utilize a highresolution 3D LGE with 1 mm isotropic spatial resolution to image the VT surrogate in swine model of VT.