Feasibility study shows concordance between image-based virtual-heart ablation targets and predicted ECG-based arrhythmia exit-sites

Shijie Zhou, Eric Sung, Adityo Prakosa, Konstantinos N. Aronis, Jonathan Chrispin, Harikrishna Tandri, Amir AbdelWahab, B. Milan Horáček, John L. Sapp, Natalia A. Trayanova

Research output: Contribution to journalArticlepeer-review


Introduction: We recently developed two noninvasive methodologies to help guide VT ablation: population-derived automated VT exit localization (PAVEL) and virtual-heart arrhythmia ablation targeting (VAAT). We hypothesized that while very different in their nature, limitations, and type of ablation targets (substrate-based vs. clinical VT), the image-based VAAT and the ECG-based PAVEL technologies would be spatially concordant in their predictions. Objective: The objective is to test this hypothesis in ischemic cardiomyopathy patients in a retrospective feasibility study. Methods: Four post-infarct patients who underwent LV VT ablation and had pre-procedural LGE-CMRs were enrolled. Virtual hearts with patient-specific scar and border zone identified potential VTs and ablation targets. Patient-specific PAVEL based on a population-derived statistical method localized VT exit sites onto a patient-specific 238-triangle LV endocardial surface. Results: Ten induced VTs were analyzed and 9-exit sites were localized by PAVEL onto the patient-specific LV endocardial surface. All nine predicted VT exit sites were in the scar border zone defined by voltage mapping and spatially correlated with successful clinical lesions. There were 2.3 ± 1.9 VTs per patient in the models. All five VAAT lesions fell within regions ablated clinically. VAAT targets correlated well with 6 PAVEL-predicted VT exit sites. The distance between the center of the predicted VT-exit-site triangle and nearest corresponding VAAT ablation lesion was 10.7 ± 7.3 mm. Conclusions: VAAT targets are concordant with the patient-specific PAVEL-predicted VT exit sites. These findings support investigation into combining these two complementary technologies as a noninvasive, clinical tool for targeting clinically induced VTs and regions likely to harbor potential VTs.

Original languageEnglish (US)
Pages (from-to)432-441
Number of pages10
JournalPACE - Pacing and Clinical Electrophysiology
Issue number3
StatePublished - Mar 2021


  • ECG
  • ischemic cardiomyopathy
  • late gadolinium-enhanced cardiac magnetic resonance imaging
  • radiofrequency (RF) ablation
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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