EHRA Practical Guide on cardiac imaging in electrophysiology

In patients planned for atrial fibrillation (AF) or ventricular tachycardia (VT) ablation and diagnosis of complications, electrophysiologists are recommended to use MRI for most procedures but to opt for CT for the detection of intramural fat and calcification prior to VT ablation, and for the diagnosis of ablation-related complications [1].

Prof. Thomas Deneke (Heart Centre Bad Neustadt, Germany) presented practical advice on the usage of CT and MR for different scenarios in clinical electrophysiology, such as monitoring implanted active devices, before or after AF and VT ablation, and monitoring complications after electrophysiology procedures. This overview aimed to inform electrophysiologists’ decisions on which technology (CT, MR, or both) and specific techniques to use in which clinical setting [1].

A standardised protocol for the inclusion of CT and MR in the planning of catheter ablation procedures was presented: pre-procedural imaging for the acquisition of imaging data, optional post-processing of imaging data, followed by integration in the mapping system by segmentation of imaging data (i.e. automatic, semi-automatic), and finally image integration and registration.

Prof. Deneke further discussed which modality (CT or MR) is ideal for which scenario in AF and VT ablation (see summary in Figure).

Figure: CT and MR imaging for AF ablation and VT ablation [1]





To aid diagnosis of ablation-related complications, CT is suitable for the detection of atrio-oesophageal fistula, oesophageal perforation (i.v. + p.o. water soluble contrast material), vascular complications, and active bleeding. Both CT and MR are suitable for diagnosis of stroke, cerebral ischaemia, and pulmonary vein stenosis.

In summary, MRI is recommended for most workflow procedures and to indicate long-term ablation lesion scars, while CT is the modality of choice in ablation-related complications.

1. 
   
   1. Deneke T. EHRA practical guide on pre- and postprocedural cardiac imaging in electrophysiology. EHRA 2021 Congress, 23-25 April.

 

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Posted on 16 June 202115 February 2024