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Preprocedural imaging guiding ventricular tachycardia ablation in structural heart disease
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Orientador(es)
Resumo(s)
Background: Integration of preprocedural imaging techniques in ventricular tachycardia (VT) ablation may improve the identification of arrhythmogenic substrates, particularly relevant for patients with nonischemic cardiomyopathy (NICM) with sub-optimal outcomes. We assessed the impact of advanced preprocedural imaging on the safety and long-term efficacy of radiofrequency catheter ablation (RCA) for VT, comparing patients with NICM and ischemic cardiomyopathy (ICM).
Methods: In this prospective, single-center study, consecutive patients referred for scar-related VT ablation underwent multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Images were segmented with ADAS 3D software and integrated into mapping systems. Substrate map collection targeted the imaging-predicted area of interest and the ablation aimed at eliminating all local abnormal ventricular activities. Procedural safety was evaluated with 30-day mortality. Long-term efficacy was assessed by survival free from appropriate ICD shocks at 36 months.
Results: 102 patients were included (67 ± 11 years, 94% male; 75 ICM, 27 NICM). All patients underwent MDCT and 35% also underwent LGE-CMR. Procedural safety (4% 30-day mortality, p = .95) and 36-month efficacy were similar in both groups (88.0% vs. 74.1%, HR 2.09; p = .13 in ICM and NICM). Efficacy was higher in patients when VT activation mapping with VT isthmus ablation complemented substrate ablation compared to substrate-based ablation alone (94.5% vs. 80.6%, HR 4.00; p < .05).
Conclusion: A preprocedural imaging protocol integrated into the invasive mapping system may improve safety and long-term efficacy, with NICM patients exhibiting outcomes comparable to those with ICM. Activation mapping of the VT on top of substrate ablation may improve prognosis.
Descrição
© 2024 The Author(s). Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Palavras-chave
VT ablation Cardiac magnetic resonance Ischemic cardiomyopathy Multidetector computed tomography Nonischemic cardiomyopathy
Contexto Educativo
Citação
J Arrhythm. 2024 Dec 19;41(1):e13205
Editora
Wiley