Outcomes of ventricular tachycardia ablation facilitated by pre-procedural cardiac imaging-derived scar characterization: a prospective multi-centre international registry

Abstract

Aims Pre-procedural imaging can facilitate scar-related ventricular tachycardia (VT) ablation, although only limited data have been reported. This prospective registry aimed to analyse procedural data and outcomes in a multi-centre setting of a pre-defined VT ablation strategy facilitated by the integration of pre-procedural imaging into the navigation system. Methods Consecutive patients referred for scar-related left-sided VT ablation were prospectively enrolled at five European tertiary and results hospitals. Pre-procedural cardiac magnetic resonance (CMR)–derived scar maps and/or multi-detector computed tomography (MDCT)–derived wall thinning maps of the left ventricle (LV) were obtained and integrated into the navigation system. An endocardial or endoepicardial approach was chosen based on the scar distribution at pre-procedural imaging. The decision of performing a detailed electro-anatomical map (EAM) of the LV (image-aided) or to using the pre-procedural imaging for guiding the ablation without obtaining an EAM (image-guided) was left to the physician’s discretion. One hundred and seventy-one patients (71% with ischaemic cardiomyopathy) were included. Cardiac magnetic resonance was integrated in 159 (93%), MDCT in 113 (66%), and both in 101 (59%) procedures. Procedure-related complications occurred in 9 (5%) patients. At a mean follow-up of 18 ± 19 months, the overall survival and VT recurrence-free survival were 91 and 74.4%, respectively. There were no significant differences in long-term ablation outcomes based on the type of cardiomyopathy (P = 0.88) or the pre-procedural imaging modality employed (P = 0.33). An image-guided approach appears feasible, safe, and faster, with reduced procedure, radiofrequency, and fluoroscopy times, without compromising efficacy. Conclusion In a large multi-centre prospective cohort, VT ablation facilitated by pre-procedural imaging is associated with favourable long-term outcomes.