Imaging Modality Selection in Cardiac Ablation

Catheter ablation as a treatment method for both ventricular and atrial arrhythmias has evolved significantly over the past 40 years since it was first performed in humans. This evolution has been paralleled by a similar expansion in both invasive and non-invasive imaging modalities directed at further elucidating cardiac morphology and arrhythmia substrate pathophysiology. Access to multimodality imaging options is a significant piece of the armamentarium available to interventional electrophysiologists who are tackling increasingly complex rhythm problems with catheter ablation. This presents a unique problem to the practicing electrophysiologist in selecting the most pertinent imaging modalities that will improve the safety and efficacy of a procedure and winnowing out potential imaging studies that offer minimal or marginal benefit. In this review, we evaluate the various modalities that are useful in planning and executing successful ablation and weigh the evidence for benefit.