https://doi.org/10.1007/s00392-024-02526-y
1Universitäts-Herzzentrum Freiburg / Bad Krozingen Klinik für Kardiologie und Angiologie Bad Krozingen, Deutschland; 2RHÖN-KLINIKUM AG Campus Bad Neustadt Klinik für Kardiologie II / Interventionelle Elektrophysiologie Bad Neustadt a. d. Saale, Deutschland; 3RHÖN-KLINIKUM AG Campus Bad Neustadt Radiologie Bad Neustadt a. d. Saale, Deutschland; 4Universitäts-Herzzentrum Freiburg / Bad Krozingen Klinik für Kardiologie und Angiologie II Bad Krozingen, Deutschland; 5Klinikum Nürnberg Klinik für Innere Medizin 8, Rhythmologie Nürnberg, Deutschland
Preprocedural imaging can facilitate procedural planning of complex electrophysiological procedures including ablation of monomorphic ventricular tachycardia (VT). Computed tomography (CT) and magnetic resonance imaging (MRI) represent cornerstones of high-resolution imaging techniques. Computer-assisted analysis and segmentation of data can help streamline procedures, however, comparison with conventional techniques are scarce.
Methods:
Consecutive patients with preprocedural imaging (CT or MRI) for first VT ablation from February 2018 to April 2021 were identified. Patients with preprocedural imaging and imaging-aided ablation (electroanatomical data was collected and used to select ablation targets) were compared to patients with conventional electroanatomical mapping. A 1:1 propensity score matching from our institutional database during the same period was performed to identify the conventional ablation group. Procedural data, acute and long-term follow-up was compared between both groups.
Results:
A total of 214 patients (107 imaging-aided, 107 conventional) undergoing a first VT ablation were included (64 ± 14 years; 88% male; 60% ischemic cardiomyopathy (ICM)). Patients with ICM and preprocedural imaging had in 59% CT (40/68) and in 41% MRI (28/68). Patients with non-ischemic cardiomyopathy (NICM) CT in 10% (4/39) and MRI in 90% (35/39). Major complications occurred in 10% of all patients. Patients with imaging had significantly reduced overall procedure time (136 ± 32 min vs. 149 ± 46 min; p=0.015) and numerically lower fluoroscopy (12.8 ± 7.9 min vs. 13.7 ± 9.4 min; p=0.505) and ablation times (25.9 ± 15.3 min vs. 36.4 ± 56.6 min; p=0.074). Non-inducibility of the clinical VT was achieved in 92% of all patients with higher rates among patients with preprocedural imaging (98% vs. 86%; p=0.014; OR 5.210, 95% CI 1.063-25.522; p=0.042). Non-inducibility of any VT was achieved in 83% with comparable rates among both groups (86% vs. 80%; p=0.273). Especially in patients with ICM preprocedural imaging was associated with successful elimination of the clinical VT (OR 10.353, 95% CI 1.254-85.456; p=0.030). After 21 ± 10 months overall VT recurrences occurred in 39% of all patients with comparable rates between both groups (40% imaging-aided vs. 37% conventional; log rank p=0.705), irrespective of ICM/NICM. All-cause mortality occurred in 25 patients (12%); patients with conventional ablation died significantly more often (18% vs. 6%; log-rank p=0.003).
Conclusions:
Imaging-aided VT ablation is feasible and safe and can help to streamline complex EP procedures. It reduces the procedural, fluoroscopy, and radiofrequency times and is associated with higher non-inducibility rates of the clinical VT.