Combination of cardiac MRI with conventional 3D-EAM to guide catheter ablation of ventricular arrhythmias in structural heart disease: A meta-analysis

BACKGROUND: Use of 3-dimensional electroanatomic mapping (3D-EAM) has become a standard when ablating ventricular arrhythmias (VA) in patients with structural heart disease (SHD). Integrating cardiac magnetic resonance imaging (CMR) with 3D-EAM might improve substrate detection and ablation outcomes. Our study aims to evaluate the outcomes of integrating CMR with 3D-EAM for VA ablation in patients with SHD. METHODS: A literature search was conducted up to December 2025, focusing on the integration of CMR into ablation procedures in patients with VA and SHD. CMR studies were categorized into CMR-guided (CMR data were merged with 3D-EAM) and CMR-aided (CMR data were used to assist in mapping or procedural approach). The control group was patients who received 3D-EAM alone. Primary endpoint was VA recurrence. Secondary endpoints were procedural success, procedural time, fluoroscopy time, radiofrequency ablation (RF) time, and major procedural-related complications. RESULTS: = 0) compared to 3D-EAM. Major procedural-related complications were low across all groups with 3%, 4%, and 2% in CMR-guided, CMR-aided, and 3D-EAM, respectively. There were no differences in procedural time, fluoroscopy time, and RF time. CONCLUSION: The CMR-guided ablation approach in patients with VA and SHD demonstrated a lower VA recurrence and higher procedural success with comparable safety to 3D-EAM alone.