Afonso Nunes-Ferreira MD, Joana Brito MD, Nuno Cortez-Dias MD, PhD, Gustavo da Lima da Silva MD, PhD, Fausto J. Pinto MD, PhD, João de Sousa MD
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We assessed the impact of advanced preprocedural imaging on the safety and long-term efficacy of radiofrequency catheter ablation (RCA) for VT, comparing patients with NICM and ischemic cardiomyopathy (ICM).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>In this prospective, single-center study, consecutive patients referred for scar-related VT ablation underwent multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Images were segmented with ADAS 3D software and integrated into mapping systems. Substrate map collection targeted the imaging-predicted area of interest and the ablation aimed at eliminating all local abnormal ventricular activities. Procedural safety was evaluated with 30-day mortality. Long-term efficacy was assessed by survival free from appropriate ICD shocks at 36 months.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>102 patients were included (67 ± 11 years, 94% male; 75 ICM, 27 NICM). All patients underwent MDCT and 35% also underwent LGE-CMR. Procedural safety (4% 30-day mortality, <i>p</i> = .95) and 36-month efficacy were similar in both groups (88.0% vs. 74.1%, HR 2.09; <i>p</i> = .13 in ICM and NICM). Efficacy was higher in patients when VT activation mapping with VT isthmus ablation complemented substrate ablation compared to substrate-based ablation alone (94.5% vs. 80.6%, HR 4.00; <i>p</i> < .05).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>A preprocedural imaging protocol integrated into the invasive mapping system may improve safety and long-term efficacy, with NICM patients exhibiting outcomes comparable to those with ICM. Activation mapping of the VT on top of substrate ablation may improve prognosis.</p>\n </section>\n </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730700/pdf/","citationCount":"0","resultStr":"{\"title\":\"Preprocedural imaging guiding ventricular tachycardia ablation in structural heart disease\",\"authors\":\"Afonso Nunes-Ferreira MD, Joana Brito MD, Nuno Cortez-Dias MD, PhD, Gustavo da Lima da Silva MD, PhD, Fausto J. Pinto MD, PhD, João de Sousa MD\",\"doi\":\"10.1002/joa3.13205\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Integration of preprocedural imaging techniques in ventricular tachycardia (VT) ablation may improve the identification of arrhythmogenic substrates, particularly relevant for patients with nonischemic cardiomyopathy (NICM) with sub-optimal outcomes. We assessed the impact of advanced preprocedural imaging on the safety and long-term efficacy of radiofrequency catheter ablation (RCA) for VT, comparing patients with NICM and ischemic cardiomyopathy (ICM).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>In this prospective, single-center study, consecutive patients referred for scar-related VT ablation underwent multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Images were segmented with ADAS 3D software and integrated into mapping systems. Substrate map collection targeted the imaging-predicted area of interest and the ablation aimed at eliminating all local abnormal ventricular activities. Procedural safety was evaluated with 30-day mortality. Long-term efficacy was assessed by survival free from appropriate ICD shocks at 36 months.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>102 patients were included (67 ± 11 years, 94% male; 75 ICM, 27 NICM). All patients underwent MDCT and 35% also underwent LGE-CMR. Procedural safety (4% 30-day mortality, <i>p</i> = .95) and 36-month efficacy were similar in both groups (88.0% vs. 74.1%, HR 2.09; <i>p</i> = .13 in ICM and NICM). Efficacy was higher in patients when VT activation mapping with VT isthmus ablation complemented substrate ablation compared to substrate-based ablation alone (94.5% vs. 80.6%, HR 4.00; <i>p</i> < .05).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>A preprocedural imaging protocol integrated into the invasive mapping system may improve safety and long-term efficacy, with NICM patients exhibiting outcomes comparable to those with ICM. 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引用次数: 0
摘要
背景:室性心动过速(VT)消融术前成像技术的整合可以提高对致心律失常底物的识别,特别是对预后不理想的非缺血性心肌病(NICM)患者。我们比较了NICM和缺血性心肌病(ICM)患者,评估了先进的术前成像对射频导管消融(RCA)治疗VT的安全性和长期疗效的影响。方法:在这项前瞻性的单中心研究中,接受疤痕相关VT消融治疗的连续患者接受了多探测器计算机断层扫描(MDCT)和晚期钆增强心脏磁共振(LGE-CMR)。使用ADAS 3D软件对图像进行分割,并整合到制图系统中。基底图收集针对成像预测的感兴趣区域,消融旨在消除所有局部异常心室活动。以30天死亡率评估手术安全性。通过36个月无适当ICD电击的生存来评估长期疗效。结果:纳入102例患者(67±11岁),94%为男性;75icm, 27nicm)。所有患者都接受了MDCT检查,35%的患者还接受了LGE-CMR检查。两组的手术安全性(30天死亡率4%,p = 0.95)和36个月疗效相似(88.0% vs. 74.1%, HR 2.09;p =。ICM和NICM中的13个)。VT激活定位与VT峡部消融辅助基质消融相比,单纯基质消融的疗效更高(94.5% vs 80.6%, HR 4.00;p结论:将手术前成像方案整合到有创测绘系统中可以提高安全性和长期疗效,NICM患者的预后与ICM患者相当。基底消融之上的VT激活定位可能改善预后。
Preprocedural imaging guiding ventricular tachycardia ablation in structural heart disease
Background
Integration of preprocedural imaging techniques in ventricular tachycardia (VT) ablation may improve the identification of arrhythmogenic substrates, particularly relevant for patients with nonischemic cardiomyopathy (NICM) with sub-optimal outcomes. We assessed the impact of advanced preprocedural imaging on the safety and long-term efficacy of radiofrequency catheter ablation (RCA) for VT, comparing patients with NICM and ischemic cardiomyopathy (ICM).
Methods
In this prospective, single-center study, consecutive patients referred for scar-related VT ablation underwent multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Images were segmented with ADAS 3D software and integrated into mapping systems. Substrate map collection targeted the imaging-predicted area of interest and the ablation aimed at eliminating all local abnormal ventricular activities. Procedural safety was evaluated with 30-day mortality. Long-term efficacy was assessed by survival free from appropriate ICD shocks at 36 months.
Results
102 patients were included (67 ± 11 years, 94% male; 75 ICM, 27 NICM). All patients underwent MDCT and 35% also underwent LGE-CMR. Procedural safety (4% 30-day mortality, p = .95) and 36-month efficacy were similar in both groups (88.0% vs. 74.1%, HR 2.09; p = .13 in ICM and NICM). Efficacy was higher in patients when VT activation mapping with VT isthmus ablation complemented substrate ablation compared to substrate-based ablation alone (94.5% vs. 80.6%, HR 4.00; p < .05).
Conclusion
A preprocedural imaging protocol integrated into the invasive mapping system may improve safety and long-term efficacy, with NICM patients exhibiting outcomes comparable to those with ICM. Activation mapping of the VT on top of substrate ablation may improve prognosis.