Computed tomography-guided vs conventional catheter ablation for ventricular tachycardia: the InEurHeart trial

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Catheter ablation for recurrent ventricular tachycardia (VT) is complex and center-dependent.
• Pre-procedural imaging guidance shows promise in non-randomized trials for VT ablation.

Purpose of the Study:

• To evaluate computed tomography (CT)-guided VT ablation versus conventional ablation in a multicenter randomized controlled trial.
• To assess if CT guidance reduces procedural duration for VT ablation.

Main Methods:

• A multicenter randomized controlled trial involving 113 patients with prior myocardial infarction and significant VT.
• Patients were assigned to either CT-guided VT ablation (n=57) or conventional VT ablation (n=56).
• Primary endpoint was reduced procedural duration; secondary endpoints included efficacy, safety, and composite outcomes.

Main Results:

• CT-guided VT ablation significantly decreased procedure time by 19% (intention-to-treat) and 28% (per protocol).
• Major adverse events were low and similar between groups (1.8% CT-guided vs. 3.5% conventional).
• One-year VT-free survival was higher in the CT-guided group (76.8% vs. 67.3%), and VT burden decreased by 90%.

Conclusions:

• CT-guided VT ablation is effective in reducing procedure duration for patients with ischaemic cardiomyopathy.
• The technique maintains a favorable safety and efficacy profile compared to conventional VT ablation.
• Image integration using CT provides a valuable advancement for VT ablation procedures.