|Breakthrough in Sudden Cardiac Death Prevention|
Noninvasive Treatment of Ventricular Tachycardia Guided
by Electrocardiographic Imaging (ECGI)
|Dr. Yoram Rudy|
In clinical electrophysiology, standard noninvasive cardiac imaging methods, such as MRI and CT, help to identify and localize myocardial scar that may have an abnormal electrical substrate causing VT. Electrocardiographic Imaging (ECGI)i,ii,iii performs cardiac electrophysiology (EP) mapping noninvasively, providing images of the arrhythmic electrical substrate and activation patterns during VTii,iii. Combined application of ECGI and standard anatomical imaging, can generate cardiac images that identify noninvasively both myocardial scar and the arrhythmogenic region from which ventricular arrhythmias originateii,iii. It was envisioned that based on these images, it could be possible to develop a completely noninvasive method for ablation of VT by application of noninvasive ablative techniques. Recently, such an approach realized (iv) the application of ECGI-guided stereotactic ablative radiation. The mean noninvasive ablation time was 14 minutes. From an aggregate 6,577 VT episodes in 5 patients during the 15 patient-months before the procedure, the number dropped to 4 episodes of VT during the 46 patient-months following a post-procedure blanking period of six weeks - a relative reduction of 99.9%. ECGIi,ii,iii provided noninvasively the essential EP information for determination and localization of the target for noninvasive ablation.
The researchers are currently enrolling patients in a clinical trial to further evaluate the approach and, to date, have performed the procedure on 23 patients.
i Electrocardiographic imaging (ECGI) was developed by Yoram Rudy; The Fred Saigh Distinguished Professor, Professor of Biomedical Engineering, Cell Biology & Physiology Medicine, Radiology, and Pediatrics; Director, Cardiac Bioelectricity and Arrhythmia Center (CBAC), Washington University in St. Louis, MO, USA, Ramanathan C, et al. Nat Med 2004; 10:422-8.
ii Wang Y, et al., Science Translational Medicine 2011;3 (issue 98):191-200 (98ra84).
iii Zhang J, et al. Pacing Clin Electrophysiol (PACE) 2016; 39:781-91.
iv Cuculich PS, et al., N Engl J Med 2017;377:2325-36.