Abstract 16057: Utilization of Advanced Cardiac Imaging Prior to Structural Ventricular Tachycardia Ablation

Introduction: Advanced imaging with cardiac magnetic resonance (CMR) or computed tomography (CCT) can be helpful for planning of ventricular tachycardia (VT) ablation procedures by defining the arrhythmogenic substrate. The frequency with which these modalities are utilized in the pre-ablation setting and the associated outcomes remain poorly studied.

Objectives: (1) Determine the utilization of advanced cardiac imaging prior to structural VT ablation; (2) establish factors associated with improved VT ablation outcomes

Methods: We retrospectively evaluated all VT ablations performed in patients with structural heart disease at a tertiary referral institution during a 2.5 year period (1/2020 - 7/2022). We documented pre-ablation use of cardiac imaging modalities and investigated their association with acute and long-term ablation outcomes. The primary outcome was time to VT recurrence, cardiac transplant, or death.

Results: Our dataset included n = 129 subjects. Median post-ablation follow-up was 17 months. Recent echocardiogram, CMR, or CCT (<3 months pre-ablation) had been performed in 113 (88%), 48 (37%), and 31 (24%) patients, respectively. CMR was not associated with procedural success, post-ablation VT recurrence (p = 1), or the composite primary outcome (p = 0.72). Similarly, recent CCT was not associated with procedural success (p = 0.5), VT recurrence (p = 0.3), or the composite primary outcome (p = 0.31). When adjusted for other variables, EF (p = 0.048), recent echo (p = 0.02), and procedural success (p = 0.013) were associated with the primary outcome, but recent CCT (p = 0.11) and CMR (p = 0.4) were not. These results did not differ significantly in patients with ischemic and non-ischemic cardiomyopathy.

Conclusions: In this large tertiary care ablation center, CMR and CCT were utilized in only a fraction of patients prior to VT ablations. In multivariate analysis, CMR or CCT were not associated with improved acute or long-term ablation outcomes.