Defining the target for stereotactic radioablation of ventricular tachycardia: The combination of cardiac imaging and electrocardiographic information matters

Figures

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  Figure 1. A: Contrast-enhanced computed tomographic scan before first ablation displays an ischemic scar at the lateral wall. B: Late contrast enhancement in the septum (arrow). C: First substrate-guided ventricular tachycardia (VT) ablation, both endocardial and epicardial. D: Second ablation activation and voltage map with pulsed-field ablation applications (dots). E: Hemodynamically unstable VT and electrogram at the ablation site.

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  Figure 2. A: Clinical ventricular tachycardia (VT). B: Twenty-four-hour Holter monitor showing biventricular pacing alternating with slow VT at a rate of 114 bpm. C: Contrast-enhanced computed tomographic (CE-CT) scan showing late enhancement in the basal anterior septum (white arrow). D: VIVO workflow: clinical VT induced with noninvasive programmed stimulation and CE-CT scan; 3-dimensional image of the torso with VIVO patches and VT exit point (orange arrow).

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  Figure 3. A: Treatment plan simulation. Planning target volume (PTV) contour, delineated by the red contour line, was obtained through an integrated “DIBH” contrast-enhanced computed tomographic (CT) scan with a planning (PL) CT scan. B: PTV and organs at risk contours in the axial, sagittal, and coronal views of the PL-CT scan. Dose distribution in the axial, sagittal, and coronal views of the PL-CT scan. C: Three-dimensional model view of 360° volumetric modulated arc therapy arcs. D: Dose-volume histogram values.