Int J Arrhythm.  2020 Sep;21(3):e12. 10.1186/s42444-020-00020-w.

Accuracy and clinical feasibility of 3D‑myocardial thickness map measured by cardiac computed tomogram

• Kwon O
• Lee J
• Lim S
• Park J
• Han H
• Yang S
• Hwang I
• Yu H
• Kim T
• Uhm J
• Joung B
• Lee M
• Pak H

• KMID: 2507232
• DOI: http://doi.org/10.1186/s42444-020-00020-w

Abstract

Background
Although myocardial thickness is an important variable for therapeutic catheter ablation of cardiac arrhythmias, quantification of wall thickness has been overlooked. We developed a software (AMBER) that measures 3D-myocardial thickness using a cardiac computed tomogram (CT) image, verified its accuracy, and tested its clinical feasibility.
Methods
We generated 3D-thickness maps by calculating wall thickness (WT) from the CT images of 120 patients’ hearts and a 3D-phantom model (PhM). The initial vector field of the Laplace equation was oriented to calculate WT with the field lines derived from the 3D mesh. We demonstrate the robustness of the Laplace WT algorithm by comparing with the real thickness of 3D-PhM, echocardiographically measured left ventricular (LV) WT, and regional left atrial (LA) WT reported from previous studies. We conducted a pilot case of catheter ablation for atrial fibrillation (AF) utilizing real-time LAWT map-guided radiofrequency (RF) energy titration.
Results
AMBER 3D-WT had excellent correlations with the real thickness of the PhM (R = 0.968, p < 0.001) and echocardiographically measured LVWT in 10 patients (R = 0.656, p = 0.007). AMBER 3D-LAWT (n = 120) showed a relatively good match with 12 previously reported regional LAWT. We successfully conducted pilot AF ablation utilizing AMBER 3D-LAWT map-guided real-time RF energy titration.
Conclusion
We developed and verified an AMBER 3D-cardiac thickness map measured by cardiac CT images for LAWT and LVWT, and tested its feasibility for RF energy titration during clinical catheter ablation.

Keyword

Myocardial thickness; Computed tomogram; Software