Imaging-Aided VT Ablation. Long-Term Results From a Pilot Study.

Area of Science:

• Cardiac Electrophysiology
• Interventional Cardiology
• Medical Imaging

Background:

• Ventricular tachycardia (VT) ablation is crucial for rhythm control in post-myocardial infarction (MI) patients.
• Current VT ablation workflows are variable and physician-dependent, highlighting the need for standardized approaches.

Purpose of the Study:

• To evaluate the initial systematic experience of VT ablation using cardiac computed tomography (CT) to target wall thickness heterogeneity.
• To assess CT-identified channels as surrogates for mapped VT isthmuses in post-MI VT ablation.

Main Methods:

• Included consecutive patients with post-MI VT undergoing their first VT ablation (Jan 2017-May 2022).
• Identified ablation targets based on wall thickness heterogeneity on CT scans.
• Performed CT-guided radiofrequency ablation aiming to block or render CT channels non-capturable, followed by inducibility testing and supplementary mapping/ablation if needed.

Main Results:

• Thirty-nine patients (97.4% male, LVEF 35±10%) were included; an average of 3.6 CT channels were identified per patient.
• Initial CT-guided ablation achieved non-inducibility in 48.7% of patients; 48.7% remained inducible, with most originating from border zones.
• After supplementary ablation, 7.7% of patients remained inducible. The long-term VT-free survival rate was 61.9% at a mean follow-up of 47.8 months.

Conclusions:

• CT-guided VT ablation targeting wall thickness heterogeneity is a feasible and safe strategy for patients with ischemic cardiomyopathy.
• This imaging-guided approach provides a systematic method for VT ablation, potentially improving rhythm control outcomes.