Your map to the heart - Cardiac CT applications in modern electrophysiology

Cardiac computed tomography (CT) has become indispensable in contemporary electrophysiology, providing rapid, non-invasive, high-resolution imaging of the heart with dramatically reduced radiation exposure compared to previous techniques. This review synthesizes the current and expanding roles of cardiac CT across a broad spectrum of electrophysiology procedures, focusing on the management of cardiac implantable electronic devices (CIEDs)-including transvenous lead extraction, leadless pacemakers, and extravascular implantable cardioverter-defibrillators-as well as atrial fibrillation therapies such as pulmonary vein isolation and left atrial appendage closure. Optimized CT protocols are essential for delineating key cardiac structures, thereby enhancing procedural planning, improving efficiency, and reducing complications. This imaging data offers essential information for procedural planning, risk stratification, and clinical decision-making to improve patient outcomes. In CIED interventions, CT serves as the gold standard for diagnosing lead-related complications, mapping fibrosis and adhesions for complex extractions, and ensuring accurate device placement. For atrial fibrillation ablation, CT is critical for excluding intracardiac thrombus, precisely mapping pulmonary vein and left atrial anatomy, and identifying procedural complications such as pulmonary vein stenosis, pericardial effusion, and atrio-esophageal fistula. In left atrial appendage closure, CT facilitates device sizing, procedural planning, and reliable detection of device-related thrombus or peri-device leaks during follow-up. As electrophysiology procedures and device technologies continue to advance, cardiac CT is poised to remain a cornerstone of procedural safety, innovation, and personalized patient care.