A Tool to Integrate Electrophysiological Mapping for Cardiac Radioablation of Ventricular Tachycardia

Overview

Journal Adv Radiat Oncol

Specialty Oncology

Date 2023 Jul 7

PMID 37415904

Authors

Hesheng Wang

Chirag R Barbhaiya

Ye Yuan

David Barbee

Ting Chen

Leon Axel

Larry A Chinitz

Andrew J Evans

David J Byun

Affiliations

Soon will be listed here.

Abstract

Purpose: Cardiac radioablation is an emerging therapy for recurrent ventricular tachycardia. Electrophysiology (EP) data, including electroanatomic maps (EAM) and electrocardiographic imaging (ECGI), provide crucial information for defining the arrhythmogenic target volume. The absence of standardized workflows and software tools to integrate the EP maps into a radiation planning system limits their use. This study developed a comprehensive software tool to enable efficient utilization of the mapping for cardiac radioablation treatment planning.

Methods And Materials: The tool, HeaRTmap, is a Python-scripted plug-in module on the open-source 3D Slicer software platform. HeaRTmap is able to import EAM and ECGI data and visualize the maps in 3D Slicer. The EAM is translated into a 3D space by registration with cardiac magnetic resonance images (MRI) or computed tomography (CT) After the scar area is outlined on the mapping surface, the tool extracts and extends the annotated patch into a closed surface and converts it into a structure set associated with the anatomic images. The tool then exports the structure set and the images as The Digital Imaging and Communications in Medicine Standard in Radiotherapy for a radiation treatment planning system to import. Overlapping the scar structure on simulation CT, a transmural target volume is delineated for treatment planning.

Results: The tool has been used to transfer Ensite NavX EAM data into the Varian Eclipse treatment planning system in radioablation on 2 patients with ventricular tachycardia. The ECGI data from CardioInsight was retrospectively evaluated using the tool to derive the target volume for a patient with left ventricular assist device, showing volumetric matching with the clinically used target with a Dice coefficient of 0.71.

Conclusions: HeaRTmap smoothly fuses EP information from different mapping systems with simulation CT for accurate definition of radiation target volume. The efficient integration of EP data into treatment planning potentially facilitates the study and adoption of the technique.

Citing Articles

Stereotactic arrhythmia radioablation for ventricular tachycardia: a review of clinical trials and emerging roles of imaging.

Kawamura M, Shimojo M, Tatsugami F, Hirata K, Fujita S, Ueda D J Radiat Res. 2024; 66(1):1-9.

PMID: 39656944 PMC: 11753837. DOI: 10.1093/jrr/rrae090.

The conversion of electroanatomic maps for compatibility with treatment planning systems in cardiac radioablation target volume definition.

Konermann S, Gerard I, Bernier M, Hijal T, Stroian G, Kopek N Med Phys. 2024; 52(2):1172-1181.

PMID: 39612368 PMC: 11788238. DOI: 10.1002/mp.17531.

Optimized target delineation procedure for the radiosurgery treatment of ventricular tachycardia: observer-independent accuracy.

Hecko J, Knybel L, Rybar M, Penhaker M, Jiravsky O, Neuwirth R Rep Pract Oncol Radiother. 2024; 29(3):280-289.

PMID: 39144262 PMC: 11321784. DOI: 10.5603/rpor.100387.

Radiation therapy for ventricular arrhythmias.

Liulu X, Balaji P, Barber J, De Silva K, Murray T, Hickey A J Med Imaging Radiat Oncol. 2024; 68(8):893-913.

PMID: 38698577 PMC: 11686466. DOI: 10.1111/1754-9485.13662.

References

Brett C, Cook J, Aboud A, Karim R, Shinohara E, Stevenson W . Novel Workflow for Conversion of Catheter-Based Electroanatomic Mapping to DICOM Imaging for Noninvasive Radioablation of Ventricular Tachycardia. Pract Radiat Oncol. 2020; 11(1):84-88. DOI: 10.1016/j.prro.2020.04.006. View

Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin J, Pujol S . 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging. 2012; 30(9):1323-41. PMC: 3466397. DOI: 10.1016/j.mri.2012.05.001. View

Brownstein J, Afzal M, Okabe T, Harfi T, Tong M, Thomas E . Method and Atlas to Enable Targeting for Cardiac Radioablation Employing the American Heart Association Segmented Model. Int J Radiat Oncol Biol Phys. 2021; 111(1):178-185. DOI: 10.1016/j.ijrobp.2021.03.051. View

van der Ree M, Blanck O, Limpens J, Lee C, Balgobind B, Dieleman E . Cardiac radioablation-A systematic review. Heart Rhythm. 2020; 17(8):1381-1392. DOI: 10.1016/j.hrthm.2020.03.013. View

Pinter C, Lasso A, Wang A, Jaffray D, Fichtinger G . SlicerRT: radiation therapy research toolkit for 3D Slicer. Med Phys. 2012; 39(10):6332-8. DOI: 10.1118/1.4754659. View

Liang X, Garnavi R, Wail S, Liang S, Prasanna P . Automatic segmentation of the left ventricle into 17 anatomical regions in cardiac MR imaging. Annu Int Conf IEEE Eng Med Biol Soc. 2016; 2015:6531-5. DOI: 10.1109/EMBC.2015.7319889. View

van der Ree M, Visser J, Planken R, Dieleman E, Boekholdt S, Balgobind B . Standardizing the Cardiac Radioablation Targeting Workflow: Enabling Semi-Automated Angulation and Segmentation of the Heart According to the American Heart Association Segmented Model. Adv Radiat Oncol. 2022; 7(4):100928. PMC: 8978276. DOI: 10.1016/j.adro.2022.100928. View

Law M, Liu B . Informatics in radiology: DICOM-RT and its utilization in radiation therapy. Radiographics. 2009; 29(3):655-67. DOI: 10.1148/rg.293075172. View

Cerqueira M, Weissman N, Dilsizian V, Jacobs A, Kaul S, Laskey W . Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002; 105(4):539-42. DOI: 10.1161/hc0402.102975. View

10.

Chin R, Hayase J, Hu P, Cao M, Deng J, Ajijola O . Non-invasive stereotactic body radiation therapy for refractory ventricular arrhythmias: an institutional experience. J Interv Card Electrophysiol. 2020; 61(3):535-543. DOI: 10.1007/s10840-020-00849-0. View

11.

Sapp J, Zhou S, Wang L . Mapping Ventricular Tachycardia With Electrocardiographic Imaging. Circ Arrhythm Electrophysiol. 2020; 13(2):e008255. PMC: 7034621. DOI: 10.1161/CIRCEP.120.008255. View

12.

Siedow M, Brownstein J, Prasad R, Loccoh E, Harfi T, Okabe T . Cardiac radioablation in the treatment of ventricular tachycardia. Clin Transl Radiat Oncol. 2021; 31:71-79. PMC: 8498093. DOI: 10.1016/j.ctro.2021.02.005. View

13.

Cuculich P, Schill M, Kashani R, Mutic S, Lang A, Cooper D . Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia. N Engl J Med. 2017; 377(24):2325-2336. PMC: 5764179. DOI: 10.1056/NEJMoa1613773. View

14.

Hohmann S, Henkenberens C, Zormpas C, Christiansen H, Bauersachs J, Duncker D . A novel open-source software-based high-precision workflow for target definition in cardiac radioablation. J Cardiovasc Electrophysiol. 2020; 31(10):2689-2695. DOI: 10.1111/jce.14660. View

15.

Duane F, Aznar M, Bartlett F, Cutter D, Darby S, Jagsi R . A cardiac contouring atlas for radiotherapy. Radiother Oncol. 2017; 122(3):416-422. PMC: 5356506. DOI: 10.1016/j.radonc.2017.01.008. View

16.

Tang P, Shenasa M, Boyle N . Ventricular Arrhythmias and Sudden Cardiac Death. Card Electrophysiol Clin. 2017; 9(4):693-708. DOI: 10.1016/j.ccep.2017.08.004. View

17.

Cheniti G, Puyo S, Martin C, Frontera A, Vlachos K, Takigawa M . Noninvasive Mapping and Electrocardiographic Imaging in Atrial and Ventricular Arrhythmias (CardioInsight). Card Electrophysiol Clin. 2019; 11(3):459-471. DOI: 10.1016/j.ccep.2019.05.004. View

18.

Lydiard PGDip S, Blanck O, Hugo G, OBrien R, Keall P . A Review of Cardiac Radioablation (CR) for Arrhythmias: Procedures, Technology, and Future Opportunities. Int J Radiat Oncol Biol Phys. 2020; 109(3):783-800. DOI: 10.1016/j.ijrobp.2020.10.036. View

19.

Lloyd M, Wight J, Schneider F, Hoskins M, Attia T, Escott C . Clinical experience of stereotactic body radiation for refractory ventricular tachycardia in advanced heart failure patients. Heart Rhythm. 2019; 17(3):415-422. DOI: 10.1016/j.hrthm.2019.09.028. View

20.

Robinson C, Samson P, Moore K, Hugo G, Knutson N, Mutic S . Phase I/II Trial of Electrophysiology-Guided Noninvasive Cardiac Radioablation for Ventricular Tachycardia. Circulation. 2018; 139(3):313-321. PMC: 6331281. DOI: 10.1161/CIRCULATIONAHA.118.038261. View