Twenty-five years of research in cardiac imaging in electrophysiology procedures for atrial and ventricular arrhythmias

Abstract

Catheter ablation is nowadays considered the treatment of choice for numerous cardiac arrhythmias in different clinical scenarios. Fluoroscopy has traditionally been the primary imaging modality for catheter ablation, providing real-time visualization of catheter navigation. However, its limitations, such as inadequate soft tissue visualization and exposure to ionizing radiation, have prompted the integration of alternative imaging modalities. Over the years, advancements in imaging techniques have played a pivotal role in enhancing the safety, efficacy, and efficiency of catheter ablation procedures. This manuscript aims to explore the utility of imaging, including electroanatomical mapping, cardiac computed tomography, echocardiography, cardiac magnetic resonance, and nuclear cardiology exams, in helping electrophysiology procedures. These techniques enable accurate anatomical guidance, identification of critical structures and substrates, and real-time monitoring of complications, ultimately enhancing procedural safety and success rates. Incorporating advanced imaging technologies into routine clinical practice has the potential to further improve clinical outcomes of catheter ablation procedures and pave the way for more personalized and precise ablation therapies in the future.

Assessing left atrial intramyocardial fat infiltration from computerized tomography angiography in patients with atrial fibrillation

“…The use of pre-procedural cardiac imaging is increasingly supported by scientific evidence for accurate diagnostic classification, prognostic stratification, and peri-procedural support. 25–28 In all patients, a pre-procedural MDCT was obtained with a Revolution™ CT scanner (General Electric Healthcare). The images were acquired during an inspiratory breath-hold using retrospective ECG-gating technique with tube current modulation set between 50% and 100% of the cardiac cycle.…”

Personalized pulmonary vein isolation with very high-power short-duration lesions guided by left atrial wall thickness: the QDOT-by-LAWT randomized trial

“…In the last few years, the use of pre-procedural cardiac imaging is increasingly supported by scientific evidence for accurate diagnostic classification, prognostic stratification, and peri-procedural support for the ablation of arrhythmias. 9–13 It has been recently shown that pre-procedural multidetector computed tomography (MDCT)-derived images can be used to obtain 3D LAWT maps. 8 , 14 Integrating these LAWT maps into the navigation system provides a real-time knowledge of the local LAWT in contact with the ablation catheter tip during the ablation.…”

Wall shear stress in outflow tract premature ventricular contraction location assessed through 4D-flow MRI

“…Premature ventricular contraction (PVC) is a frequent cardiac arrhythmia 1 and numerous electrophysiological causes have been proposed to explain PVC occurrence 2 , 3 . However, the exact mechanistic origin of PVCs is unclear and the development of cardiac imaging particularly with cardiovascular magnetic resonance imaging (CMR) 4 has shown that PVCs can be associated with underlying substrate abnormalities only diagnosed with CMR.…”