The Use of Pre- and Peri-Procedural Imaging During VT Ablation

Ventricular arrhythmias, including ventricular tachycardia (VT), ventricular fibrillation (VF), and premature ventricular complexes (PVCs), may occur in structurally normal hearts and in the context of structural heart disease. In those patients with recurrent arrhythmias despite medical therapy, catheter ablation may be considered. To successfully suppress ventricular arrhythmias, an understanding of the substrate for the arrhythmias is crucial.

Advances in cross-sectional imaging used prior to VT ablation permit accurate localisation of fibrosis that represents the substrate for VT, allowing an operator to focus the electrophysiologic assessment during a procedure and effectively target all relevant parts of the substrate. In addition, the use of imaging during a procedure allows registration of pre-procedural cross-sectional imaging as well as real-time substrate assessment and allows the operator to visualise tissue-catheter contact for the most effective lesion delivery.

In this review, the role of pre-procedural cardiac computed tomographic (CCT) imaging and cardiovascular magnetic resonance (CMR) imaging and the peri-procedural use of intra-cardiac echocardiography (ICE) are discussed.