Ablation of ventricular tachycardia using computed tomography inHEART three-dimensional cardiac model

Abstract Background The ablation of ventricular tachycardia (VT) is becoming the mainstay of therapy in patients with sustained VT. The development of inHEART software as a three-dimensional (3D) cardiac model based on high-resolution cross-section computed tomography (CT) imaging allows preoperative planning for VT ablations and therefore targeted elimination of VT isthmi. Purpose To report a single-center experience regarding the use of inHEART imaging software for VT ablations and compare the procedural characteristics and outcomes to legacy procedures. Methods This was a retrospective, single-center analysis of 2 patient cohorts. All patients experienced sustained VT that required DC conversion before the ablation. First cohort consisted of twenty consecutive ablation cases using inHEART imaging software. Second cohort consisted of the last 20 consecutive cases that were performed conventionally. The procedures were performed using Carto3 system with high density substrate mapping in all patients and inHEART model merge in the first cohort. Primary endpoint was non-inducibility of VT. Secondary endpoint was the absence of VT recurrence during a three-month follow up verified by ICD interrogation. Results A total of 40 patients (mean age 63.3 ± 10.9 years, male 92.5%) were included in the study. Majority of patients suffered from ischemic cardiomyopathy (75.0% vs. 95.0%, p=0.176). There were no significant differences in patients’ characteristics. Furthermore, there was no significant differences in procedural characteristics (Table 1). There were 3 major complications in total, and all consisted of total AV block (2 in inHEART cohort vs. 1 in conventional, p=0.548). Moreover, there was no significant differences both for primary and secondary outcomes (Table 2). Conclusion The use of CT inHEART 3D cardiac model enables more detailed preoperative planning for VT ablations. There was no significant difference in procedural characteristics, complications and outcomes in two cohorts. Further research and application of this new approach is needed to demonstrate potential clinical benefits.