Integrating advanced cardiac imaging modalities like CMR, MDCT, PET, and ECHO into electro-anatomical mapping systems improves substrate definition and procedural planning for scar-related VT ablation.
Integrating advanced imaging modalities like CMR, MDCT, and PET with traditional electro-anatomical mapping enhances scar characterization and procedural planning for ventricular tachycardia ablation.
Abstract: Ventricular tachycardia (VT) ablation is a crucial intervention for patients at risk of sudden cardiac death, particularly in those with scar-related VT. Despite advancements, traditional electro-anatomical mapping (EAM) remains limited in fully characterising the complex arrhythmogenic substrate, resulting in notable recurrence rates. This review details the synergistic role of advanced cardiac imaging modalities–echocardiography (ECHO), cardiac magnetic resonance (CMR), multidetector computed tomography (MDCT) and positron emission tomography (PET)–in overcoming these challenges. Each modality offers unique strengths, from ECHO’s real-time guidance to MDCT’s exquisite anatomical detail, and PET’s functional assessment of inflammation and metabolism. Crucially, CMR emerges as a cornerstone, providing gold-standard myocardial tissue characterisation, precise scar delineation and the identification of critically protected heterogeneous tissue channels that are highly predictive of re-entry. Advanced software, such as MUltimodality Platform for Specific Imaging in Cardiology and Automatic Detection of Arrhythmic Substrate three-dimensional segmentation, further enhances scar characterisation from imaging data. By integrating these diverse imaging insights into EAM systems, electrophysiologists can achieve more accurate substrate definition, refine procedural planning and ultimately improve patient outcomes in the demanding landscape of scar-related VT ablation.
Devendra Bisht (Tue,) conducted a review in Ventricular tachycardia. Advanced cardiac imaging modalities (ECHO, CMR, MDCT, PET) vs. Traditional electro-anatomical mapping (EAM) was evaluated. Integrating advanced cardiac imaging modalities like CMR, MDCT, PET, and ECHO into electro-anatomical mapping systems improves substrate definition and procedural planning for scar-related VT ablation.