ADAS - A novel image integration system between MRI and electroanatomic mapping – first experience in Israel

Introduction: Use of cardiac magnetic resonance imaging (C-MRI) to identify potential arrhythmic substrate may be beneficial. New imaging software (Automatic Detection of Arrhythmic Substrate (ADAS-3D), Galgo Medical ltd, Barcelona) allows preprocedural C-MRI based 3-D reconstruction of atrial and ventricular scar as well ventricular conducting channels, a potential VT ablation targets, inside the scar. We describe our initial experience with this software in the treatment of complex arrhythmias.

Methods: Four consecutive patients with either atrial (n=2) or ventricular arrhythmias (n=2) underwent C-MRI followed by image processing via the ADAS-3D software. Thereafter, processed images were uploaded to the CARDO 3 navigation system.

Results:

Patient 1: Underwent redo atypical atrial flutter ablation. The software demonstrated patchy scaring of the left atrium and extensive scarring of the interatrial septum. Atrial scaring as evidenced by Carto-3 mapping was similar to the ADAS-based analysis. The flutter was mapped to the atrial septum and terminated by ablating from both sides of the septum.

Patient 2: Underwent persistent AF ablation. A good correlation of scar location and extent was seen between Carto-3 and ADAS-3D. As the posterior wall was diffusely scared the patient underwent pulmonary vein as well as posterior wall isolation.

Patient 3: Had non-ischemic CMP with 2 previous failed PVC ablations. He was hospitalized with sustained septal VT and PVC’S. On ADAS-3D a scar with 1 channel below the aortic valve was demonstrated. Ablating at that area terminated the PVC’s. However the VT was terminated in a septal area slightly remote from that potential channel.

Patient 4: Underwent endocardial scar mapping due to suspected ARVD. A good correlation was seen between the bipolar voltage map endocardially and the unipolar map epicardially. A similar scar area was noticed on ADAS-3D.

Conclusions: ADAS-3D software may aid in planning and targeting ablation of scar related atrial and ventricular arrhythmias.