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 an overview of a manuscript currently being finalised, which gives practical advice on the usage of CT and MRI for different scenarios in patients planned for or after AF and VT ablation and patients with complications after ablation procedures. The presented data should help electrophysiologists decide on which technology (i.e. CT, MRI, or both) and specific techniques to use in which clinical setting.

A standardised protocol for the inclusion of CT and MRI 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 (automatic, semi-automatic), and finally image integration and registration. Prof. Deneke further discussed which modality (CT or MRI) is ideal in AF and VT ablation:

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  • MRI can be used for the majority of workflow procedures, except for the detection of intramural fat and calcification prior to VT ablation, for which CT is more suitable.
  • MRI imaging at 3 months post-procedure best indicates the long-term ablation lesion scar in patients with AF ablation.
  • CT is the modality of choice for the diagnosis of ablation-related complications (incl. fistula, perforation, bleeding, stenosis, and ischaemic events).

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

Posted on 25 April, 202116 June, 2021