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Image-guided ablation of scar-related ventricular tachycardia: towards a shorter and more predictable procedure.

Authors
  • Berte, Benjamin1
  • Cochet, Hubert2
  • Dang, Lam3
  • Mahida, Saagar4
  • Moccetti, Federico5
  • Hilfiker, Gabi5
  • Bondietti, Joel6
  • Ruschitzka, Frank7
  • Jaïs, Pierre2
  • Scharf, Christoph7
  • Kobza, Richard5
  • 1 Heart Centrum, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Switzerland. [email protected] , (Switzerland)
  • 2 University of Bordeaux; IHU LIRYC ANR-10-IAHU-04 ; Equipex MUSIC ANR-11-EQPX-0030, CHU Bordeaux, Bordeaux, France. , (France)
  • 3 Herzgefässzentrum, Klinik Im Park, Zürich, Switzerland. , (Switzerland)
  • 4 Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool, L14 3PE, UK.
  • 5 Heart Centrum, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Switzerland. , (Switzerland)
  • 6 Biosense Webster, Johnson and Johnson, Zug, Switzerland. , (Switzerland)
  • 7 Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland. , (Switzerland)
Type
Published Article
Journal
Journal of Interventional Cardiac Electrophysiology
Publisher
Springer-Verlag
Publication Date
Dec 01, 2020
Volume
59
Issue
3
Pages
535–544
Identifiers
DOI: 10.1007/s10840-019-00686-w
PMID: 31858334
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The aim of this study was to analyze the feasibility and reproducibility of using image integration software at a remote setting over the MUSIC network to perform image-guided VT ablation. Furthermore, we analyzed the efficacy of a focused workflow with electroanatomical mapping (EAM) limited to imaging-defined scar. In a prospective two-centre study, consecutive patients undergoing image integration-guided VT ablation (magnetic resonance [DE-MRI] and/or multidetector computed tomography [MDCT]) were included. Patients were divided into two groups (Group 1, complete EAM; Group 2, EAM limited to imaging-defined substrate). Forty-nine patients (62 ± 15 years; 90% male; LVEF 41 ± 14%; ischemic 69%) who underwent image integration-guided VT ablation were included (MDCT 98%; DE-MRI in 35%). Total procedure time was 172 ± 48 min (ablation 31 ± 17 min; fluoroscopy 23 ± 13 min). Procedure time was shorter in Group 2 as compared to Group 1 (Group 2 [n = 26] vs. Group 1 [n = 23]; procedure time: 151 ± 33 vs. 180 ± 53 min, P = 0.01). Non-inducibility of all VT was achieved in 37 (76%), with no difference between Group 1 and 2 (Group 2 vs. Group 1; VT non-inducibility 71 vs. 74%, P = 0.8). During a follow-up period of 19 ± 8 months, 13 patients (27%) had a VT recurrence. Two patients (4%) died during follow-up. There were no differences in VT-free survival between Group 1 and Group 2 (p = 0.77). Image-integrated VT ablation is feasible through a network between highly experienced centers and remotely located centers. Focused image integration-guided VT ablation is associated with short and predictable procedure duration, achieving high-long term success rates.

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