Publication
Preprocedural imaging guiding ventricular tachycardia ablation in structural heart disease
| Summary: | Background: Integration of preprocedural imaging techniques in ventricular tachycardia (VT) ablation may improve the identification of arrhythmogenic substrates, particularly relevant for patients with nonischemic cardiomyopathy (NICM) with sub-optimal outcomes. We assessed the impact of advanced preprocedural imaging on the safety and long-term efficacy of radiofrequency catheter ablation (RCA) for VT, comparing patients with NICM and ischemic cardiomyopathy (ICM). Methods: In this prospective, single-center study, consecutive patients referred for scar-related VT ablation underwent multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Images were segmented with ADAS 3D software and integrated into mapping systems. Substrate map collection targeted the imaging-predicted area of interest and the ablation aimed at eliminating all local abnormal ventricular activities. Procedural safety was evaluated with 30-day mortality. Long-term efficacy was assessed by survival free from appropriate ICD shocks at 36 months. Results: 102 patients were included (67 ± 11 years, 94% male; 75 ICM, 27 NICM). All patients underwent MDCT and 35% also underwent LGE-CMR. Procedural safety (4% 30-day mortality, p = .95) and 36-month efficacy were similar in both groups (88.0% vs. 74.1%, HR 2.09; p = .13 in ICM and NICM). Efficacy was higher in patients when VT activation mapping with VT isthmus ablation complemented substrate ablation compared to substrate-based ablation alone (94.5% vs. 80.6%, HR 4.00; p < .05). Conclusion: A preprocedural imaging protocol integrated into the invasive mapping system may improve safety and long-term efficacy, with NICM patients exhibiting outcomes comparable to those with ICM. Activation mapping of the VT on top of substrate ablation may improve prognosis. |
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| Main Authors: | Ferreira, Afonso Nunes |
| Other Authors: | Brito, Joana; Cortez-Dias, Nuno; Lima da Silva, Gustavo; Pinto, Fausto J.; De Sousa, João |
| Subject: | VT ablation Cardiac magnetic resonance Ischemic cardiomyopathy Multidetector computed tomography Nonischemic cardiomyopathy |
| Year: | 2024 |
| Country: | Portugal |
| Document type: | article |
| Access type: | open access |
| Associated institution: | Universidade de Lisboa |
| Language: | English |
| Origin: | Repositório da Universidade de Lisboa |
| Summary: | Background: Integration of preprocedural imaging techniques in ventricular tachycardia (VT) ablation may improve the identification of arrhythmogenic substrates, particularly relevant for patients with nonischemic cardiomyopathy (NICM) with sub-optimal outcomes. We assessed the impact of advanced preprocedural imaging on the safety and long-term efficacy of radiofrequency catheter ablation (RCA) for VT, comparing patients with NICM and ischemic cardiomyopathy (ICM). Methods: In this prospective, single-center study, consecutive patients referred for scar-related VT ablation underwent multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Images were segmented with ADAS 3D software and integrated into mapping systems. Substrate map collection targeted the imaging-predicted area of interest and the ablation aimed at eliminating all local abnormal ventricular activities. Procedural safety was evaluated with 30-day mortality. Long-term efficacy was assessed by survival free from appropriate ICD shocks at 36 months. Results: 102 patients were included (67 ± 11 years, 94% male; 75 ICM, 27 NICM). All patients underwent MDCT and 35% also underwent LGE-CMR. Procedural safety (4% 30-day mortality, p = .95) and 36-month efficacy were similar in both groups (88.0% vs. 74.1%, HR 2.09; p = .13 in ICM and NICM). Efficacy was higher in patients when VT activation mapping with VT isthmus ablation complemented substrate ablation compared to substrate-based ablation alone (94.5% vs. 80.6%, HR 4.00; p < .05). Conclusion: A preprocedural imaging protocol integrated into the invasive mapping system may improve safety and long-term efficacy, with NICM patients exhibiting outcomes comparable to those with ICM. Activation mapping of the VT on top of substrate ablation may improve prognosis. |
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