Catheter Ablation -> Ventricular Arrhythmias -> Mapping & Imaging D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-098 - Ct-channel Based Approach For Fast And Simple Post-MI VT Ablation (ID 1363)


Background: VT ablation is typically a long procedure with 80% of the duration dedicated to EP mapping.
Objective: We sought to assess the feasibility of CT-channel based ablation strategy without using any mapping.
Methods: Twenty-four patients (21 M, 67 ±8 years) with post MI VT (EF 36±7%) were included. They had inferior/lateral (60%) or Anterior MI (40%) and were treated by Amiodarone in 47%. Aortic geometry was briefly famed using the navigated ablation catheter to register CT-meshes to 3D-EAM without EP mapping (Figure A). Ablation was then delivered at CT channels (Figure B).
Results: A mean of 3.8+/-2.0 CT-channels were found, with length, width, and area of CT-channels of 33.0±16mm, 11±8mm, and 3.7±0.82cm2, respectively. LV thickness was 2.6±1.0mm on channels center, and 1.8±0.8mm on the borders. RF (35 to 50W) delivered for 35±23 min - with the end point of loss of local pacing capture (10mA) - rendered 92% of tested patients non-inducible acutely. The procedure duration was 98±21 min while the fluoroscopy time was 22±18 min. No major complications were seen. VT recurrence rate at 6 months was 13% (3/24).
Conclusion: This study demonstrates that highly detailed 3D reconstructed CT registered to 3D-EAM can guide post-MI VT ablation without EP mapping. This usually complex procedure becomes simpler and faster, being consistently completed within less than 2 hours.