Preprocedural Substrate Visualization and Image Integration Based on Late Enhancement Computed Tomography for...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Imaging

Background:

• Catheter ablation is a standard therapy for ventricular tachycardia (VT).
• Outcomes for VT ablation in non-ischemic dilated cardiomyopathy (NIDCM) are often limited by complex arrhythmogenic substrates.
• Late iodine enhancement computed tomography (LIE-CT) shows potential for preprocedural substrate visualization, offering an alternative to cardiac MRI.

Purpose of the Study:

• To evaluate procedural characteristics and outcomes of LIE-CT-supported VT ablation compared to conventional mapping (CM) in NIDCM patients.
• To assess the safety and efficiency of LIE-CT for substrate visualization and ablation guidance in NIDCM.

Main Methods:

• Retrospective analysis of NIDCM patients undergoing VT ablation between January 2022 and August 2024.
• LIE-CT data processed using inHEART software for substrate mapping.
• Propensity score matching (1:1) based on baseline characteristics, electrical storm, and prior ablations for LIE-CT and CM groups.

Main Results:

• 46 patients included (23 LIE-CT, 23 CM); procedure durations were similar.
• LIE-CT group showed significantly shorter mapping time (35.9 vs. 54 min) and fluoroscopy time (14.7 vs. 21.3 min).
• Higher epicardial access rate (52% vs. 26%) in LIE-CT group; no significant difference in acute kidney injury or 30-day mortality; VT-free survival at median 367 days was 57% (LIE-CT) vs. 52% (CM).

Conclusions:

• LIE-CT-supported VT ablation is safe and efficient for NIDCM patients, reducing procedural times without increasing acute kidney injury risk.
• The technique enables more targeted VT ablation, with comparable long-term VT-free survival to conventional mapping.
• Prospective studies are needed to confirm the impact of LIE-CT on long-term outcomes in NIDCM.