Preprocedural Substrate Visualization and Image Integration Based on Late Enhancement Computed Tomography for Ventricular Tachycardia Ablation in Non-Ischemic Cardiomyopathy

<b>Background/Objectives</b>: Catheter ablation is an established therapy for ventricular tachycardia (VT), though outcomes remain limited in patients with non-ischemic dilated cardiomyopathy (NIDCM) due to complex arrhythmogenic substrates. Late iodine enhancement computed tomography (LIE-CT) offers a promising alternative to cardiac MRI for preprocedural substrate visualization. This study evaluated procedural characteristics and outcomes of LIE-CT-supported VT ablation versus conventional mapping (CM) in NIDCM patients. <b>Methods</b>: NIDCM patients undergoing VT ablation between January 2022 and August 2024 were retrospectively analyzed. LIE-CT data were processed using inHEART software. Patients were matched 1:1 by propensity score based on baseline characteristics, electrical storm, and prior ablations. <b>Results</b>: A total of 46 patients (mean age 59 ± 16.4 years, 74% male) were included (23 LIE-CT, 23 CM). Procedure durations were comparable (231.5 ± 74.2 vs. 220.2 ± 70.2 min, <i>p</i> = 0.5), but mapping time (35.9 ± 15.3 vs. 54 ± 5 min, <i>p</i> < 0.001) and fluoroscopy time (14.7 ± 5.1 vs. 21.3 ± 10.6 min, <i>p</i> = 0.02) were significantly shorter with LIE-CT. Epicardial access was more frequent (52% vs. 26%, <i>p</i> < 0.001), and bipolar ablation for intramural scar was performed in 17% of LIE-CT cases. There were no significant differences in acute kidney injury or 30-day mortality. At a median follow-up of 367 days, VT-free survival was 57% with LIE-CT and 52% with CM (<i>p</i> = 0.8). <b>Conclusions</b>: LIE-CT-supported VT ablation and substrate visualization was safe, without additional risk of acute kidney injury, and enabled more efficient and targeted VT ablation. Prospective studies are warranted to assess its impact on long-term outcomes in NIDCM patients.