Po-05-091 acute and mid-term clinical outcomes of ischemic scar-related vt ablation guided by real-time intraprocedural rapid-vt system for localizing vt exit sites on patient-specific 3d geometry: a pilot case-control study

We have previously developed an intraprocedural system to identify VT exit sites in real-time on the patient-specific CT/MRI geometry using 3-lead ECGs (leads III, V2, V6) during catheter ablation for ventricular tachycardia (RAPID-VT). To assess prospectively the localization performance and clinical outcomes of using the RAPID-VT system to guide catheter ablation. 8 consecutive consenting patients with ischemic cardiomyopathy undergoing VT ablation who had preprocedural CT/MRI scans were included. A reconstructed LV endocardial mesh surface was registered to the electroanatomic shell during the procedure and imported into the RAPID-VT program. During the procedure, predicted VT exit sites were used to guide mapping and ablation (Figure). The localization accuracy was quantified by comparing estimated sites against sites clinically identified using activation, entrainment, and pace mapping. Acute and mid-term clinical outcomes were compared to a control group of 8 consecutive patients with ischemic cardiomyopathy who underwent catheter ablation. Baseline clinical characteristics were similar between the 2 groups. The RAPID-VT system had localization accuracy of 8.6±3.2 mm. There were trends toward less RF time, RF applications and fluoroscopy times with RAPID-VT procedures. Overall procedure time and complications were similar. VT was noninducible in a higher proportion of patients in the RAPID-VT group. (7/8 vs. 1/8, p=0.01). A trend towards less VT recurrences or need for repeat ablations at 12 months was observed. (Table) In this pilot study, RAPID-VT system was feasibly used in real-time to guide VT mapping and ablation with exit site localization error <10 mm. Clinical outcomes compared favorably with control patients. Validation in larger studies is required.Tabled 1Comparison between the 2 groupsRAPID-VT (n=8)Control (n=8)BaselineAge (years)68±767±9LVEF (%)39±1136±8Amiodarone use prior to ablation75ProcedureProcedure duration (min)284±33288±65Total RF time (min)28.7±8.636.1±21.3Number of RF applications49±1557±38Fluoroscopy time (min) ¶12.7±3.521±10.1All clinical VTs interrupted with RF53Non-inducible at end of procedure§71Follow-upICD shocks @ 12 months13ICD therapies @ 12 months24VT recurrence @ 12 months36Time to recurrence (days)*70 (288)32.5 (302)* Median (range) § Fisher’s exact test p=0.01 ¶ Fisher’s exact test p=0.06 Open table in a new tab