Improved Multimodality Data Fusion of Late Gadolinium Enhancement MRI to Left Ventricular Voltage Maps in Ventricular Tachycardia Ablation

Electroanatomical voltage mapping (EAVM) is commonly performed prior to catheter ablation of scar-related ventricular tachycardia (VT) to locate the arrhythmic substrate and to guide the ablation procedure. EAVM is used to locate the position of the ablation catheter and to provide a 3-D reconstruction of left-ventricular anatomy and scar. However, EAVM measurements only represent the endocardial scar with no transmural or epicardial information. Furthermore, EAVM is a time-consuming procedure, with a high operator dependence and has low sampling density, i.e., spatial resolution. Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) allows noninvasive assessment of scar morphology that can depict 3-D scar architecture. Despite the potential use of LGE as a roadmap for VT ablation for identification of arrhythmogenic substrate, its utility has been very limited. To allow for identification of VT substrate, a correlation is needed between the substrates identified by EAVM as the gold standard and LGE-MRI scar characteristics. To do so, a system must be developed to fuse the datasets from these modalities. In this study, a registration pipeline for the fusion of LGE-MRI and EAVM data is presented. A novel surface registration algorithm is proposed, integrating the matching of global scar areas as an additional constraint in the registration process. A preparatory landmark registration is initially performed to expedite the convergence of the algorithm. Numerical simulations were performed to evaluate the accuracy of the registration in the presence of errors in identifying landmarks in EAVM or LGE-MRI datasets as well as additional errors due to respiratory or cardiac motion. Subsequently, the accuracy of the proposed fusion system was evaluated in a cohort of ten patients undergoing VT ablation where both EAVM and LGE-MRI data were available. Compared to landmark registration and surface registration, the presented method achieved significant improvement in registration error. The proposed data fusion system allows the fusion of EAVM and LGE-MRI data in VT ablation with registration errors less than 3.5 mm.