Pre-procedural image-guided versus non-image-guided ventricular tachycardia ablation—a review

Abstract

Background Magnetic resonance imaging and computed tomography in patients with ventricular tachycardia (VT) after myocardial infarction (MI) helps to delineate scar from healthy tissue. Image-guided VT ablation has not yet been studied on a large scale. Objective The aim of the meta-analysis was to compare the long-term outcome of image-guided VT ablation with a conventional approach for VT after MI. Methods Eight electronic bibliographic databases were searched to identify all relevant studies from 2012 until 2018. The search for scientific literature was performed for studies that described the outcome of VT ablation in patients with an ischaemic substrate. The outcome of image-guided ablation was compared with the outcome of conventional ablations. Results Of the 2990 citations reviewed for eligibility, 38 articles—enrolling a total of 7748 patients—were included into the meta-analysis. Five articles included patients with image-guided ablation. VT-free survival was 82% [74–90] in the image-guided VT ablation versus 59% [54–64] in the conventional ablation group (p < 0.001) during a mean follow-up of 35 months. Overall survival was 94% [90–98] in the image-guided versus 82% [76–88] in the conventional VT ablation group (p < 0.001). Conclusions Image-guided VT ablation in ischaemic VT was associated with a significant benefit in VT-free and overall survival as compared with conventional VT ablation. Visualising myocardial scar facilitates substrate-guided ablation procedures, pre-procedurally and by integrating imaging during the procedure, and may consequently improve long-term outcome.

Cardiac Magnetic Resonance for Ventricular Tachycardia Ablation and Risk Stratification

“…Despite several studies proving the feasibility of the integration of CMR images into a navigation system to assist VT ablation, few studies comparing image-guided VT ablation with standard procedures have been published. Overall, only five studies (non-randomised) ( 46 – 50 ) and one meta-analysis ( 51 ) have been published. Some of the studies ( 48 , 49 ) suggest that the use of imaging is associated with shorter procedure time, shorter radiofrequency time, and shorter fluoroscopy time.…”

High-resolution structural-functional substrate-trigger characterization: Future roadmap for catheter ablation of ventricular tachycardia

“…Recent advances in the field of catheter ablation for scar-related VT have primarily focused on defining target locations for ablation through pre-procedural characterization of the ventricular scar architecture by combining imaging techniques [such as computed tomography (CT) or cardiac magnetic resonance imaging (CMR)] with electrocardiogram (ECG)-VT algorithms. Image-guided or -aided substrate ablation may increase long-term success, decrease recurrence rates and reduce procedural duration ( 7 , 8 ). Imaging-based approaches mostly focus on structural myocardial targets, ignoring 3D functional information such as activation/propagation maps, repolarization maps, wavefront direction or arrhythmia triggers.…”

Long‐term success of a multi‐electrode substrate mapping and ablation strategy versus a classic single tip mapping and ablation strategy for ventricular tachycardia ablation in patients with ischemic cardiomyopathy

“…Over the past years, mapping and ablation techniques for the treatment of ventricular tachycardia have evolved rapidly. Entrainment mapping and pace mapping are still performed, but high‐density (HD) substrate mapping (during sinus rhythm or ventricular pacing) and pre‐procedural imaging to assess the location and characteristics of the myocardial scar have demonstrated promising results 5–7 . Most studies have reported short‐term outcome.…”