Image-guided ablation of scar-related ventricular tachycardia: towards a shorter and more predictable procedure

Purpose The aim of this study was to analyze the feasibility and reproducibility of using image integration software at a remote setting over the MUSIC network to perform image-guided VT ablation. Furthermore, we analyzed the efficacy of a focused workflow with electroanatomical mapping (EAM) limite...

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Published in:	Journal of interventional cardiac electrophysiology 2020-12, Vol.59 (3), p.535-544
Main Authors:	Berte, Benjamin, Cochet, Hubert, Dang, Lam, Mahida, Saagar, Moccetti, Federico, Hilfiker, Gabi, Bondietti, Joel, Ruschitzka, Frank, Jaïs, Pierre, Scharf, Christoph, Kobza, Richard
Format:	Article
Language:	eng
Subjects:	Ablation Cardiology Computed tomography Feasibility Fluoroscopy Integration Ischemia Magnetic resonance imaging Medical imaging Medicine Medicine & Public Health Substrates Tachycardia Ventricle Workflow
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Summary:	Purpose The aim of this study was to analyze the feasibility and reproducibility of using image integration software at a remote setting over the MUSIC network to perform image-guided VT ablation. Furthermore, we analyzed the efficacy of a focused workflow with electroanatomical mapping (EAM) limited to imaging-defined scar. Methods In a prospective two-centre study, consecutive patients undergoing image integration-guided VT ablation (magnetic resonance [DE-MRI] and/or multidetector computed tomography [MDCT]) were included. Patients were divided into two groups (Group 1, complete EAM; Group 2, EAM limited to imaging-defined substrate). Results Forty-nine patients (62 ± 15 years; 90% male; LVEF 41 ± 14%; ischemic 69%) who underwent image integration-guided VT ablation were included (MDCT 98%; DE-MRI in 35%). Total procedure time was 172 ± 48 min (ablation 31 ± 17 min; fluoroscopy 23 ± 13 min). Procedure time was shorter in Group 2 as compared to Group 1 (Group 2 [ n = 26] vs. Group 1 [ n = 23]; procedure time: 151 ± 33 vs. 180 ± 53 min, P = 0.01). Non-inducibility of all VT was achieved in 37 (76%), with no difference between Group 1 and 2 (Group 2 vs. Group 1; VT non-inducibility 71 vs. 74%, P = 0.8). During a follow-up period of 19 ± 8 months, 13 patients (27%) had a VT recurrence. Two patients (4%) died during follow-up. There were no differences in VT-free survival between Group 1 and Group 2 ( p = 0.77). Conclusion Image-integrated VT ablation is feasible through a network between highly experienced centers and remotely located centers. Focused image integration-guided VT ablation is associated with short and predictable procedure duration, achieving high-long term success rates.
ISSN:	1383-875X 1572-8595