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: 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: 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: 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: A CCT-based pre-procedural assessment pre-VT ablation is feasible, showing high diagnostic concordance with EAM in detecting myocardial fibrosis.
Pre-procedural imaging with cardiac computed tomography for endo-epicardial ventricular tachycardia ablation / C. Carbucicchio, F. Guarracini, M. Schiavone, A. Gasperetti, E. Conte, A. Preda, S. Cellucci, P. De Iuliis, V. Catto, S. Mushtaq, M.E. Mancini, F. Marchetti, L. Bianchini, F. Tundo, M. Moltrasio, D. Andreini, G. Pontone, C. Tondo. - In: HEART RHYTHM. - ISSN 1547-5271. - (2024), pp. 1-8. [Epub ahead of print] [10.1016/j.hrthm.2024.06.025]
Pre-procedural imaging with cardiac computed tomography for endo-epicardial ventricular tachycardia ablation
M. Schiavone;A. Gasperetti;E. Conte;S. Mushtaq;F. Marchetti;L. Bianchini;F. Tundo;D. Andreini;G. Pontone;C. Tondo
2024
Abstract
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: 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: 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: 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: A CCT-based pre-procedural assessment pre-VT ablation is feasible, showing high diagnostic concordance with EAM in detecting myocardial fibrosis.File | Dimensione | Formato | |
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