Sacristan Benjamin, Cochet Hubert, Bouyer Benjamin, Tixier Romain, Duchateau Josselin, Derval Nicolas, Pambrun Thomas, Arnaud Marine, Charton Jan, Ditac Geoffroy, Plant Allan, Fitzgerald John, Sdiri-Cheniti Soumaya, Verhaege Laurens, Montaudon Michel, Hocini Mélèze, Haissaguerre Michel, Sermesant Maxime, Jais Pierre, Sacher Frederic
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
IHU LIRYC, Université de Bordeaux-Inserm, Pessac, France.
J Cardiovasc Electrophysiol. 2025 Aug;36(8):1841-1848. doi: 10.1111/jce.16741. Epub 2025 May 26.
Ventricular tachycardia (VT) ablation has become a cornerstone of patient care, especially for post-MI VT. Several strategies have proven effective for achieving rhythm control in this population, but the workflow is highly variable and depends on the physician's experience.
This study describes the initial systematic experience of VT ablation targeting wall thickness heterogeneity on a cardiac computed tomography (CT) scanner used as a surrogate for mapped VT isthmii.
Consecutive patients with post-MI VT, a CT scan, and a first VT ablation were included from January 2017 to May 2022. Targets were identified based on wall thickness heterogeneity. After image integration, ablation with > 10 grams, 40-50 W was performed with the aim of blocking the CT channels/render them non-capturable. Only then was inducibility tested. Inducible VT, if any, were conventionally mapped and ablated with the aim of reaching non-inducibility.
Thirty-nine patients (97.4% male, age: mean LVEF 35 ± 10%) were included. The mean number of identified CT Channels was 3.6 ± 1.8/patient. Non-inducibility was achieved in 19 (48.7%) of patients after initial imaging-guided ablation, while at least one VT could be induced in 19 (48.7%). Among these patients, 4 had VT related to unblocked or reconnected CT-determined VT channels, and 15 from other areas (border zone), typically with faster cycle length. After further mapping and ablation, 3 (7.7%) patients remained inducible. Mean radiofrequency time was 35 ± 19 min for CT Channels ablation, with an additional 11 ± 8 min for supplementary ablation (global mean RF time 35 ± 19 min). With a mean follow-up of 47.8 ± 24.3 months, 61.9% (95% CI: 44.0%-75.5%) remained VT free.
CT-guided ablation represents a feasible and safe strategy for VT ablation in patients with an ischemic cardiomyopathy.
室性心动过速（VT）消融已成为患者治疗的基石，尤其是对于心肌梗死后室性心动过速。已证实几种策略对于在该人群中实现节律控制有效，但工作流程高度可变且取决于医生的经验。
本研究描述了在心脏计算机断层扫描（CT）扫描仪上以壁厚度异质性为靶点进行室性心动过速消融的初步系统经验，该扫描仪用作标测室性心动过速峡部的替代物。
纳入2017年1月至2022年5月期间连续的心肌梗死后室性心动过速患者、CT扫描以及首次室性心动过速消融患者。基于壁厚度异质性确定靶点。图像整合后，以>10克、40 - 50瓦进行消融，目的是阻断CT通道/使其不可激动。然后才进行诱发性测试。诱发性室性心动过速（如有）按常规进行标测和消融，目的是达到不可诱发性。
纳入39例患者（男性占97.4%，年龄：平均左心室射血分数35±10%）。每位患者识别出的CT通道平均数量为3.6±1.8个。初始影像引导消融后，19例（48.7%）患者实现了不可诱发性，而19例（48.7%）患者至少可诱发一种室性心动过速。在这些患者中，4例室性心动过速与未阻断或重新连接的CT确定的室性心动过速通道有关，15例来自其他区域（边界区），通常周期长度更快。经过进一步标测和消融后，3例（7.7%）患者仍可诱发。CT通道消融的平均射频时间为35±19分钟，补充消融额外需要11±8分钟（总体平均射频时间35±19分钟）。平均随访47.8±24.3个月，61.9%（95%可信区间：44.0% - 75.5%）患者无室性心动过速复发。
CT引导下消融是缺血性心肌病患者室性心动过速消融的一种可行且安全的策略。
