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Background <p>Functional mapping tools such as Coherent Mapping (CM) and Isochronal Late Activation Mapping (ILAM) allow visualization of conduction slowing and block during ventricular tachycardia (VT) ablation; however, their anatomical correlates within computed tomography (CT)–derived myocardial wall-thickness (WT) maps are incompletely defined. We aimed to evaluate the spatial relationship between CT-derived WT characteristics and functional electroanatomical markers and to assess the predictive value of WT-derived conduction channels (WTC) for identifying critical VT isthmuses.</p> Methods <p>Seven consecutive patients with ischemic cardiomyopathy undergoing VT ablation and pre-procedural contrast-enhanced CT were analyzed. WT maps and WTCs were reconstructed using the inHeart™ platform and integrated with CARTO 3 electroanatomical maps. CM-SCZs, ILAM-DZs, and lines of blocks (LOBs) were identified using predefined criteria and projected onto WT models. Local WT values, overlap with WT ≤ 5&#xa0;mm regions, and Dice similarity coefficients were calculated to quantify anatomical–functional concordance.</p> Results <p>Eighteen CM-SCZs, 15 ILAM-DZs, and 12 LOBs were identified. Functional regions predominantly localized within thinned myocardium (WT ≤ 5&#xa0;mm). Mean WT was 3.6 ± 0.8&#xa0;mm for SCZs, 3.8 ± 0.9&#xa0;mm for DZs, and 4.2 ± 1.1&#xa0;mm for LOBs, compared with 6.3 ± 1.3&#xa0;mm in remote myocardium (<i>p</i> &lt; 0.01). SCZs overlapped with WT ≤ 5&#xa0;mm areas by 74 ± 12% (Dice 0.67 ± 0.10), while DZs showed 70 ± 15% overlap (Dice 0.63 ± 0.11). Direct correspondence between WTCs and SCZs occurred in 50% of cases.</p> Conclusions <p>Although CT-derived WTCs identify regions at risk, functional mapping remains essential for precise substrate delineation. Integrated CT and CM/ILAM analysis may enhance targeting efficiency during VT ablation.</p> Graphical Abstract <p></p>

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Bridging anatomy and function in ischemic VT: CT wall-thickness and coherent mapping insights

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月22日

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  • Kivanc Yalin,
  • Hakan Yalman,
  • Ali Ugur Soysal,
  • Sebnem Durmaz,
  • İlayda Bilgili Altuntas,
  • Baris İkitimur,
  • Ahmet Kaya Bilge,
  • Kazim Serhan Ozcan,
  • Henry D. Huang,
  • Tolga Aksu

摘要

Background

Functional mapping tools such as Coherent Mapping (CM) and Isochronal Late Activation Mapping (ILAM) allow visualization of conduction slowing and block during ventricular tachycardia (VT) ablation; however, their anatomical correlates within computed tomography (CT)–derived myocardial wall-thickness (WT) maps are incompletely defined. We aimed to evaluate the spatial relationship between CT-derived WT characteristics and functional electroanatomical markers and to assess the predictive value of WT-derived conduction channels (WTC) for identifying critical VT isthmuses.

Methods

Seven consecutive patients with ischemic cardiomyopathy undergoing VT ablation and pre-procedural contrast-enhanced CT were analyzed. WT maps and WTCs were reconstructed using the inHeart™ platform and integrated with CARTO 3 electroanatomical maps. CM-SCZs, ILAM-DZs, and lines of blocks (LOBs) were identified using predefined criteria and projected onto WT models. Local WT values, overlap with WT ≤ 5 mm regions, and Dice similarity coefficients were calculated to quantify anatomical–functional concordance.

Results

Eighteen CM-SCZs, 15 ILAM-DZs, and 12 LOBs were identified. Functional regions predominantly localized within thinned myocardium (WT ≤ 5 mm). Mean WT was 3.6 ± 0.8 mm for SCZs, 3.8 ± 0.9 mm for DZs, and 4.2 ± 1.1 mm for LOBs, compared with 6.3 ± 1.3 mm in remote myocardium (p < 0.01). SCZs overlapped with WT ≤ 5 mm areas by 74 ± 12% (Dice 0.67 ± 0.10), while DZs showed 70 ± 15% overlap (Dice 0.63 ± 0.11). Direct correspondence between WTCs and SCZs occurred in 50% of cases.

Conclusions

Although CT-derived WTCs identify regions at risk, functional mapping remains essential for precise substrate delineation. Integrated CT and CM/ILAM analysis may enhance targeting efficiency during VT ablation.

Graphical Abstract