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Integration of functional mapping and image-guided structural information in ventricular tachycardia ablation-Sense2
Nikolaos Papageorgiou1, Fatima Bangash2, Dominiki Ladopoulou3
1Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
Background:
Functional substrate mapping techniques are increasingly used in clinical practice but can involve protracted mapping and procedure time.
Objective:
We incorporated magnetic resonance imaging- and computed tomography-derived ventricular scar data into the functional mapping workflow to assess the efficacy and outcomes compared to conventional ablation strategies.
Methods:
In this prospective multicenter registry, 166 patients with post-infarct ventricular tachycardia (VT) were enrolled into a prospective propensity score-matched registry. Cardiac magnetic resonance imaging/computed tomography scans were obtained to target focused regions for functional mapping and ablation (Sense2). The results were compared with those from a group that underwent mapping without image guidance (Sense) and a group that underwent activation/entrainment or substrate-guided mapping and ablation without functional mapping or image guidance (Institutional).
Results:
The mean procedural time in the Sense2 group (145.8 ± 28.7 minutes) was significantly shorter than that in the Sense group (171.0 ± 51.1 minutes) and the Institutional group (221.4 ± 73.9 minutes) (P < .0001). Similarly, the mean mapping time was shorter in the Sense2 group (25.4 ± 7.3 minutes) than that in the Sense group (47.2 ± 8.9 minutes). Ablation time was significantly reduced in the Sense2 group (18.1± 11.6 minutes) compared with the Sense group (21.6 ± 12.7 minutes) and the Institutional group (25.9 ± 13.9 minutes) (P = .006). Patients in the Sense2 and Sense groups had higher freedom from VT (P < .001 for both) and improved survival (P < .05 for both) than did those in the Institutional group.
Conclusion:
Sense2 protocol, integrating imaging with functional mapping, reduced procedural times by enabling focused substrate mapping to be performed and improved outcomes in terms of VT freedom compared with Institutional ablation. The improved survival requires corroboration with multicenter randomized trials.
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