Key result
CT wall thinning-guided ablation achieves 2-year VT freedom in a patient with ischemic VT.
Why the study?
Does pre-procedural CT imaging to identify anatomical channels improve ablation outcomes in a patient with ischemic VT?
Case Report (n=1)
No
Does pre-procedural CT imaging to identify anatomical channels improve ablation outcomes in a patient with ischemic VT?
Pre-procedural CT wall thinning data can successfully identify anatomical channels to guide effective ablation of ischemic VT.
May support CT-guided ablation feasibility in ischemic VT; hypothesis-generating and requires prospective validation before practice change.
We demonstrated a 47 year-old woman with ischemic-VT with repetitive ICD-shocks, requiring ablation. Pre-procedural CT demonstrated a single anatomical channel on the inferior-basal infarcted area between <3mm wall thinning area and the mitral annulus, which suggested the circuit of two VTs observed. Additionally, distribution of <2mm and <3mm scars can explain the mechanism of the variation of QRS morphology and S-QRS interval during entrainment. Ablation on this region resulted in no VT- inducibility and absence of any VTs for 2yrs. CT wall thinning data may allow us to understand the mechanism and circuit of VT and aid VT ablation procedures.
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Takigawa et al. (2020) conducted a case report in Ischemic ventricular tachycardia (n=1). Ablation guided by pre-procedural CT was evaluated on VT-inducibility and recurrence. Ablation guided by pre-procedural CT wall thinning data resulted in no VT-inducibility and absence of any VTs for 2 years in a patient with ischemic VT.
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