Arrhythmias & electrophysiologyDiagnostic or prognostic study

Image Integration to Identify Histologic and Electroanatomic Ventricular Scar

JACC Clin ElectrophysiolPublished

  • validation study
  • co-registered histological data
  • subsequent clinical validation study

Authors' conclusion

ADAS-3D and inHEART image integration provide similar characterization of scar distribution and allowed similar display of the anatomic relation of critical re-entry circuit sites detected by mapping to scar. However, limitations exist in the performance of these technologies to identify epicardial and noncompact scar.

Study context

Population
Sheep with anteroseptal infarction undergoing electroanatomic mapping; human subjects with ventricular tachycardia (VT) (postinfarction or nonischemic cardiomyopathy)Five sheep, 5 human subjects · sheep Five · human subjects 5
Comparison
Cardiac magnetic resonance (CMR) segmented by ADAS-3D and inHEART validated with histology for 3 layers (the endocardium, intramural layer, and epicardium)

Performance

As reported in the abstract

Accuracy to identify endocardial and intramural scar vs whole-heart histology

Comparable accuracy with moderate agreement

>75%

Further findings

Accuracy in the epicardial layers

Modest accuracy and fair agreement
60%-68%

Identification of noncompact scar

Both technologies performed poorly

Colocalization of critical sites of VT with ADAS-3D and inHEART scar

Falling within 1 scar layer
88%

VT critical sites with CMR late gadolinium enhancement scar in more than 1 layer

VT critical sites
More than 80%

Original publication

Image Integration to Identify Histologic and Electroanatomic Ventricular Scar. JACC Clin Electrophysiol. Published 8 January 2026. doi:10.1016/j.jacep.2025.10.032

Summarised from the published abstract; every number is checked against it