Pre-procedural imaging with cardiac computed tomography for endo-epicardial ventricular tachycardia ablation.
cardiac computer tomography
cardiac magnetic resonance
catheter ablation
electroanatomical mapping
ventricular tachycardia
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
20 Jun 2024
20 Jun 2024
Historique:
received:
24
10
2023
revised:
24
05
2024
accepted:
05
06
2024
medline:
23
6
2024
pubmed:
23
6
2024
entrez:
22
6
2024
Statut:
aheadofprint
Résumé
Studies evaluating the systematic use of cardiac computer tomography (CCT) for the pre-procedural assessment of myocardial fibrosis are limited and their implementation in the electrophysiology workflow has not been extensively described. To explore the degree of concordance between cardiac fibrosis evaluated by CCT compared to electroanatomical mapping (EAM) in patients undergoing endo-epicardial ventricular tachycardia (VT) ablation. From November-2017 to December-2021, patients undergoing endo-epicardial VT catheter ablation (CA) with CCT as the only source of pre-procedural scar assessment were prospectively enrolled. After image integration, myocardial fibrosis detected with CCT was compared with low voltage areas identified by endo-epicardial EAM. Post-procedural VT recurrences of this approach were evaluated after at least one-year follow-up. 35 patients (mean age 60.7±13.2 years, 94.2% males) were enrolled. The most common underlying arrhythmic substrate was dilated cardiomyopathy (48.6%). CCT was employed for contraindications to cardiac magnetic resonance, as unstable VTs (31.4%) or non-conditional ICDs (28.8%), but also for patients' and operators' preferences (14.3%-25.7%). Myocardial fibrosis was correctly identified by CCT and EAM, with strong agreement between these two techniques, both overall (Cohen's Kappa for agreement=0.933) and in per-segment analysis (K ranging from 0.796 to 1.0). Ischemic patients showed the best correlation (K=1.000) while myocarditis showed the worst (K=0.750). After a median follow-up of 14 [12-24] months, 1-year freedom from recurrences was achieved in 74.3% patients; overall freedom from recurrences was 60.0%. A CCT-based pre-procedural assessment pre-VT ablation is feasible, showing high diagnostic concordance with EAM in detecting myocardial fibrosis.
Sections du résumé
BACKGROUND
BACKGROUND
Studies evaluating the systematic use of cardiac computer tomography (CCT) for the pre-procedural assessment of myocardial fibrosis are limited and their implementation in the electrophysiology workflow has not been extensively described.
OBJECTIVE
OBJECTIVE
To explore the degree of concordance between cardiac fibrosis evaluated by CCT compared to electroanatomical mapping (EAM) in patients undergoing endo-epicardial ventricular tachycardia (VT) ablation.
METHODS
METHODS
From November-2017 to December-2021, patients undergoing endo-epicardial VT catheter ablation (CA) with CCT as the only source of pre-procedural scar assessment were prospectively enrolled. After image integration, myocardial fibrosis detected with CCT was compared with low voltage areas identified by endo-epicardial EAM. Post-procedural VT recurrences of this approach were evaluated after at least one-year follow-up.
RESULTS
RESULTS
35 patients (mean age 60.7±13.2 years, 94.2% males) were enrolled. The most common underlying arrhythmic substrate was dilated cardiomyopathy (48.6%). CCT was employed for contraindications to cardiac magnetic resonance, as unstable VTs (31.4%) or non-conditional ICDs (28.8%), but also for patients' and operators' preferences (14.3%-25.7%). Myocardial fibrosis was correctly identified by CCT and EAM, with strong agreement between these two techniques, both overall (Cohen's Kappa for agreement=0.933) and in per-segment analysis (K ranging from 0.796 to 1.0). Ischemic patients showed the best correlation (K=1.000) while myocarditis showed the worst (K=0.750). After a median follow-up of 14 [12-24] months, 1-year freedom from recurrences was achieved in 74.3% patients; overall freedom from recurrences was 60.0%.
CONCLUSIONS
CONCLUSIONS
A CCT-based pre-procedural assessment pre-VT ablation is feasible, showing high diagnostic concordance with EAM in detecting myocardial fibrosis.
Identifiants
pubmed: 38908459
pii: S1547-5271(24)02738-3
doi: 10.1016/j.hrthm.2024.06.025
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Inc.