Lattice-tip catheter for septal ventricular tachycardia ablation guided by preprocedural imaging

BACKGROUND: Outcomes after ventricular tachycardia (VT) ablation in patients with a septal substrate are poor. OBJECTIVE: This study aimed to evaluate a strategy for septal VT ablation combining substrate imaging and a large-footprint dual-energy catheter. METHODS: Patients presenting with drug-refractory VT in the setting of a predominantly septal substrate identified on preoperative imaging were prospectively included. Ablation targets were identified through a combination of imaging-based substrate identification and conventional endocardial mapping data. They were targeted using a large-footprint dual-energy catheter. RESULTS: 12 procedures were performed in 10 consecutive patients. 9 of them had at least 1 previous failed ablation procedure, including nonstandard radiofrequency (RF) ablation strategies in 5. 6 of them were in a VT storm at the time of ablation. Substrate imaging using a computed tomography scan with late iodine acquisition showed intramural septal substrate in all. Noninducibility was reached in 83% of the procedures. 60% remained free from VT after the last procedure with a mean follow-up time of 9.9 ± 2.2 months. The ablation protocol was adapted during the study. In the last 5 patients, where the final optimized ablation protocol was used combining pulsed field and RF energy, 80% remained free from VT. CONCLUSION: Septal VT ablation using a strategy combining substrate imaging and large-footprint dual-energy lattice-tip catheter leads to a high rate of noninducibility and good outcomes during short-term follow-up, especially when combining RF and pulsed field energy.