Cardiac Arrhythmia

Development of Image Analysis Techniques for Improved Treatment of Cardiac Arrhythmia

Dutch Technology Foundation (STW)

Qian Tao, PhD

Background

Cardiac arrhythmias, including atrial fibrillation (AF) and ventricular tachycardia (VT), are the most common causes (50-70%) of sudden cardiac death (SCD) worldwide -. With the global population ageing, the prevalence of cardiac arrhythmias is expected to further rise in the next few decades. However, today’s arrhythmia treatment is still suboptimal and costly. A major concern is the lack of accurate risk stratification techniques to select patients who would benefit from the implantable cardioverter defibrillator (ICD), which results in overutilization of this expensive ICD therapy (±50,000 Euro per implantation). Another issue is the high complexity and suboptimal success rate of radiofrequency (RF) catheter ablation procedures. Finding the proper ablation location is hampered by the limited information that is available during the procedure, especially in the presence of a highly complex arrhythmogenic substrate. A typical VT ablation procedure therefore often lasts for more than 6 hours and is associated with significant X-ray radiation exposure for both patients and interventional cardiologists.

Three-dimensional (3D) imaging modalities, including magnetic resonance imaging (MRI) and computed tomography (CT), show great potential in advancing the state-of-art cardiac arrhythmia treatment in terms of both risk stratification and procedure guidance. These noninvasive imaging modalities can accurately depict the cardiac structures, and the diseased myocardial tissue that serves as the arrhythmia substrate. When thoroughly analyzed, the patient-specific anatomical and pathological information can help reach an effective roadmap for individualized arrhythmia treatment. However, the lack of dedicated analysis methods, especially those for the myocardial scar, is the current bottleneck for further exploration, validation, and utilization of the image information for arrhythmia research and treatment.

Goals

The goal of this research is the development of novel image analysis methods to extract relevant features from MRI and CT images, which will help advance the two important clinical aspects in arrhythmia treatment: improvedrisk stratification and ablationprocedure guidance.

The research has the following sub-goals:

  • Development of automated image segmentation and registration methods to generate pre-interventional maps of cardiac anatomy, myocardial scar, and epicardial fat;
  • Development of objective and reproducible myocardial tissue characterization methods;
  • Development of pattern recognition methods to establish risk stratifiers from image features;
  • Development of pattern recognition methods to predict potential RF target regions;
  • Technical and clinical validation of the developed methods with multi-center clinical data.

Publications

  • Dzyubachyk O, Tao Q, Poot DH, Lamb HJ, Zeppenfeld K, Lelieveldt BP, van der Geest RJ. Super-resolution reconstruction of late gadolinium-enhanced MRI for improved myocardial scar assessment. J Magn Reson Imaging. 2014 Sep 19. doi: 10.1002/jmri.24759. [Epub ahead of print]
  • Tao Q, Lamb HJ, Zeppenfeld K, van der Geest RJ. Myocardial scar identification based on analysis of Look-Locker and 3D late gadolinium enhanced MRI. Int J Cardiovasc Imaging. 2014 Jun;30(5):925-34. doi: 10.1007/s10554-014-0402-3. Epub 2014 Mar 19.
  • Watanabe E, Abbasi SA, Heydari B, Coelho-Filho OR, Shah R, Neilan TG, Murthy VL, Mongeon FP, Barbhaiya C, Jerosch-Herold M, Blankstein R, Hatabu H, van der Geest RJ, Stevenson WG, Kwong RY. Infarct Tissue Heterogeneity by Contrast-Enhanced Magnetic Resonance Imaging Is A Novel Predictor of Mortality in Patients with Chronic Coronary Artery Disease and Left Ventricular Dysfunction. Circ Cardiovasc Imaging. 2014 Oct 6. pii: CIRCIMAGING.113.001293. [Epub ahead of print].
  • Dzyubachyk O, Tao Q, Poot DH, Lamb H, Zeppenfeld K, Lelieveldt BP, van der Geest RJ. Improved myocardial scar characterization by super-resolution reconstruction in late gadolinium enhanced MRI. Med Image Comput Comput Assist Interv. 2013;16(Pt 3):147-54.
  • Piers SR, Tao Q, van Huls van Taxis CF, Schalij MJ, van der Geest RJ, Zeppenfeld K. Contrast-enhanced MRI-derived scar patterns and associated ventricular tachycardias in nonischemic cardiomyopathy: implications for the ablation strategy. Circ Arrhythm Electrophysiol. 2013;6(5):875-883.
  • Piers SR, van Huls van Taxis CF, Tao Q, van der Geest RJ, Askar SF, Siebelink HM, Schalij MJ, Zeppenfeld K. Epicardial substrate mapping for ventricular tachycardia ablation in patients with non-ischaemic cardiomyopathy: a new algorithm to differentiate between scar and viable myocardium developed by simultaneous integration of computed tomography and contrast-enhanced magnetic resonance imaging. Eur Heart J. 2013;34:586-596.
  • van Huls van Taxis CF, Wijnmaalen AP, Piers SR, van der Geest RJ, Schalij MJ, Zeppenfeld K. Real-time integration of MDCT-derived coronary anatomy and epicardial fat: impact on epicardial electroanatomic mapping and ablation for ventricular arrhythmias. JACC Cardiovasc Imaging. 2013;6(1):42-52.
  • Piers SR, van Huls van Taxis CF, Tao Q, van der Geest RJ, Askar SF, Siebelink HM, Schalij MJ, Zeppenfeld K. Epicardial substrate mapping for ventricular tachycardia ablation in patients with non-ischaemic cardiomyopathy: a new algorithm to differentiate between scar and viable myocardium developed by simultaneous integration of computed tomography and contrast-enhanced magnetic resonance imaging. Eur Heart J. 2013;34:586-596.
  • Godeschalk-Slagboom CJ, van der Geest RJ, Zeppenfeld K, Botha CP. Cardiac MRI visualization for ventricular tachycardia ablation. Int J Comput Assist Radiol Surg. 2012;7(5):753-767.
  • Tao Q, Milles J, van Huls van Taxis C, Lamb HJ, Reiber JH, Zeppenfeld K, van der Geest RJ. Toward Magnetic Resonance-Guided Electroanatomical Voltage Mapping for Catheter Ablation of Scar-Related Ventricular Tachycardia: A Comparison of Registration Methods. J Cardiovasc Electrophysiol. 2012;23(1):74-80.
  • Wijnmalen AP, van der Geest RJ, van Huls van Taxis CF, Siebelink HM, Kroft LJ, Bax JJ, Reiber JHC, Schalij MJ, Zeppenfeld K. Head-to-head comparison of contrast-enhanced magnetic resonance imaging and electroanatomical voltage mapping to assess post-infarct scar characteristics in patients with ventricular tachycardias: Real-time image integration and reversed registration. Eur Heart J 2011;32(1):104-114.
  • Zeppenfeld K, van der Geest RJ. The infarct characteristics on magnetic resonance imaging and ventricular tachycardia: do we see what we need to see? Europace. 2011;13(6):770-772.
  • Boyé P, Abdel-Aty H, Zacharzowsky U, Bohl S, Schwenke C, van der Geest RJ, Dietz R, Schirdewan A, Schulz-Menger J. Prediction of life-threatening arrhythmic events in patients with chronic myocardial infarction by contraste Enhanced CMR. JACC Cardiovasc Imaging. 2011;4(8):871-879.
  • Tao Q, Milles J, Zeppenfeld K, Lamb HJ, Bax JJ, Reiber JH, van der Geest RJ. Automated segmentation of myocardial scar in late enhancement MRI using combined intensity and spatial information. Magn Reson Med. 2010;64(2):586-594.
  • Roes SD, Borleffs CJW, van der Geest RJ, Westenberg JJM, Ajmone Marsan N,. Kaandorp TAM, Reiber JHC, Zeppenfeld K, Lamb HJ, de Roos A, Schalij MJ, Bax JJ. Infarct Tissue Heterogeneity Assessed with Contrast-Enhanced Magnetic Resonance Imaging Predicts Spontaneous Ventricular Arrhythmia in Patients with Ischemic Cardiomyopathy and Implantable Cardioverter-Defibrillator. Circ Cardiovasc Imaging 2009;2(3):183-190.

Contact

Rob J. van der Geest, PhD.
Division of Image Processing
Department of Radiology, 1-C2S
Leiden University Medical Center
P.O. Box 9600
2300 RC Leiden, The Netherlands
Tel. +31 (0)71 526 2138
e-mail: R.J.van_der_Geest@lumc.nl

Qian Tao, PhD,
Division of Image Processing
Department of Radiology, 1-C2S
Leiden University Medical Center
P.O. Box 9600
2300 RC Leiden, The Netherlands
Tel. +31 (0)71 526 6206
email: Q.Tao@lumc.nl