Integration of cardiac computed tomography with catheter ablation for ventricular tachycardia in patients with ischaemic heart disease
M Sammut, D Hunnybun, R Oatham, M Mills, J Lee, P Metherall, K Karunasaagarar, N Kelland, G Kirkwood, T Nelson, J Sahu, A KyriacouAbstract
Background
Catheter ablation is an effective therapy for ventricular tachycardia (VT) secondary to ischaemic heart disease (IHD) but its wider adoption is limited by procedure complexity and safety. Pre-procedural planning with cardiac computed tomography (CT) and its integration into electro-anatomical mapping (EAM) during ablation has sought to address some of the associated challenges.
Purpose
The aim of this study was to investigate the impact of integrating pre-procedural cardiac CT on VT catheter ablation outcomes in patients with IHD.
Methods
A retrospective study was performed on patients who underwent catheter ablation for VT secondary to ischaemic cardiomyopathy in our centre between 2015 and 2024. Procedure details and 1-year outcomes were compared between patients whose pre-procedural CT was or was not integrated with EAM during ablation.
Results
79 patients were included, 54% with CT integration (n=43) and 46% without (n=36). All procedures were performed endocardially and all patients had implantable cardioverter-defibrillators (ICDs) at the time. PAINESD risk scores were similar (median 12 in both groups, p=0.317). Fluoroscopy dose and procedure time were similar in both groups but ablation time was reduced in procedures with CT integration (median 26.8 vs 30.6 mins, p=0.032). There was no difference in acute complications between groups. At 1 year, VT recurrence and incidence of ICD shock were reduced in the group with CT integration (26 vs 44%, log-rank p=0.024 and 14 vs 31%, log-rank p=0.037, respectively).
Conclusions
Integrating pre-procedural CT with EAM in VT ablation for patients with IHD reduced ablation time without increasing total procedure time. This more focussed ablation strategy was associated with a 1-year reduction in VT recurrence and ICD shocks.KM curves for VT-free survival at 1 year3D-reconstructed CT vs voltage map