Key result
Pre- and peri-procedural CMR, CCT, and ICE characterize arrhythmogenic substrates to guide VT ablation.
Why the study?
To successfully suppress recurrent ventricular arrhythmias with catheter ablation, an accurate understanding and targeting of the arrhythmia substrate is crucial.
Advanced cross-sectional imaging (CMR, CCT) and intra-cardiac echocardiography are invaluable tools for characterizing the anatomic substrate of ventricular arrhythmias and guiding catheter ablation.
Advanced imaging may aid VT ablation planning; leaves open impact on outcomes pending prospective trials.
Purpose of review Ventricular arrhythmias, including ventricular tachycardia (VT), ventricular fibrillation (VF), and premature ventricular complexes (PVCs), may occur in structurally normal hearts and in the context of structural heart disease. In those patients with recurrent arrhythmias despite medical therapy, catheter ablation may be considered. To successfully suppress ventricular arrhythmias, an understanding of the substrate for the arrhythmias is crucial. Recent findings Advances in cross-sectional imaging used prior to VT ablation permit accurate localisation of fibrosis that represents the substrate for VT, allowing an operator to focus the electrophysiologic assessment during a procedure and effectively target all relevant parts of the substrate. In addition, the use of imaging during a procedure allows registration of pre-procedural cross-sectional imaging as well as real-time substrate assessment and allows the operator to visualise tissue-catheter contact for the most effective lesion delivery. Summary In this review, the role of pre-procedural cardiac computed tomographic (CCT) imaging and cardiovascular magnetic resonance (CMR) imaging and the peri-procedural use of intra-cardiac echocardiography (ICE) are discussed.
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Whitaker et al. (2024) conducted a review in Ventricular tachycardia. Pre- and peri-procedural imaging (CMR, CCT, ICE) was evaluated. Pre- and peri-procedural imaging modalities, including cardiovascular magnetic resonance, cardiac computed tomography, and intra-cardiac echocardiography, provide detailed characterization of the arrhythmogenic substrate to guide ventricular tachycardia ablation.
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