Ramos-Prada, AlbaRedondo-Rodríguez, AndrésRoca-Luque, IvoPorta-Sánchez, AndreuTer Bekke, Rachel M AQuintanilla, Jorge GSánchez-González, JavierPeinado, RafaelMerino, Jose LuisCluitmans, MatthijsHoltackers, Robert JMarina-Breysse, ManuelGalán-Arriola, CarlosEnríquez-Vázquez, DanielVázquez-Calvo, SaraAlfonso-Almazán, José ManuelPizarro, GonzaloIbáñez, BorjaGonzález-Ferrer, Juan JoséSalgado-Aranda, RicardoCañadas-Godoy, VictoriaCalvo, DavidPérez-Villacastín, JuliánPérez-Castellano, NicasioFilgueiras-Rama, David2024-11-292024-11-292024-10-03https://hdl.handle.net/20.500.12105/25826The Centro Nacional de Investigaciones Cardiovasculares (CNIC) is supported by the Ministry of Science, Innovation and Universities (MCIU) and the Pro CNIC Foundation and is a Severo Ochoa Center of Excellence (CEX2020-001041-S). This study was also supported by grants from the Fondo Europeo de Desarrollo Regional (CB16/11/ 00458), the MCIU (PID2019-109329RB-I00), and the Heart Rhythm Association of the Spanish Society of Cardiology. The study was partially supported by the Fundación Interhospitalaria para la Investigación Cardiovascular (FIC, Madrid, Spain) and the Fundación Eugenio Rodríguez Pascual (Madrid, Spain). A.R.-P. was also supported by the FIC.There is lack of agreement on late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging processing for guiding ventricular tachycardia (VT) ablation. We aim at developing and validating a systematic processing approach on LGE-CMR images to identify VT corridors that contain critical VT isthmus sites. This is a translational study including 18 pigs with established myocardial infarction and inducible VT undergoing in vivo characterization of the anatomical and functional myocardial substrate associated with VT maintenance. Clinical validation was conducted in a multicentre series of 33 patients with ischaemic cardiomyopathy undergoing VT ablation. Three-dimensional LGE-CMR images were processed using systematic scanning of 15 signal intensity (SI) cut-off ranges to obtain surface visualization of all potential VT corridors. Analysis and comparisons of imaging and electrophysiological data were performed in individuals with full electrophysiological characterization of the isthmus sites of at least one VT morphology. In both the experimental pig model and patients undergoing VT ablation, all the electrophysiologically defined isthmus sites (n = 11 and n = 19, respectively) showed overlapping regions with CMR-based potential VT corridors. Such imaging-based VT corridors were less specific than electrophysiologically guided ablation lesions at critical isthmus sites. However, an optimized strategy using the 7 most relevant SI cut-off ranges among patients showed an increase in specificity compared to using 15 SI cut-off ranges (70 vs. 62%, respectively), without diminishing the capability to detect VT isthmus sites (sensitivity 100%). Systematic imaging processing of LGE-CMR sequences using several SI cut-off ranges may improve and standardize procedure planning to identify VT isthmus sites.engVoRhttp://creativecommons.org/licenses/by/4.0/Imaging processingMagnetic resonance imagingRadiofrequency ablationVentricular tachycardiaAttribution 4.0 International392986642610euae244Europaceopen access