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

Abstract Background and Aims Catheter ablation is performed in patients with recurrent ventricular tachycardia (VT) but remains complex and limited to experienced centres. Ventricular tachycardia ablation guided by pre-procedural imaging was shown promising in non-randomized trials. InEurHeart aims to evaluate computed tomography (CT)-guided VT ablation vs conventional ablation in a multicentre randomized controlled trial. Methods In 14 European centres, 113 patients with prior myocardial infarction and clinically significant VT were randomly assigned to CT-guided (n = 57) or conventional (n = 56) VT ablation. The primary objective was to demonstrate reduced procedural duration when using CT guidance. Secondary endpoints included efficacy (incidence and burden of ventricular arrhythmia), safety, as well as composite endpoints. Results The primary endpoint showed a significant decrease in procedure time favouring CT-guided ablation: 149 ± 51 to 120 ± 50 min, −19% 95% confidence interval (CI) −32; −7; P = .0027 in intention to treat, and 149 ± 51 to 107 ± 38 min, −28% (95% CI −40; −16); P .0001 per protocol. Major adverse events occurred in two (3.5%) in the conventional group vs one (1.8%) in the CT-guided group −1.8% (95% CI −7.9; 4.3). Ventricular tachycardia–free survival at 1 year was achieved in 37 (67.3%) patients for conventional vs 43 (76.8%) for CT-guided VT ablation 9.5% (95% CI −10.4; 29.4), P = NS. Ventricular tachycardia burden was decreased by 90% in the CT-guided group. Conclusions In patients with ischaemic cardiomyopathy, CT-guided VT ablation reduces the procedure duration while maintaining a favourable efficacy and safety profile when compared with VT ablation without image integration.