Research Article| Volume 16, ISSUE 3, P262-265, May 2022

Live integration of comprehensive cardiac CT with electroanatomical mapping in patients with refractory ventricular tachycardia

Published:December 21, 2021DOI:



      Aim of the present study was to verify the feasibility and accuracy of live integration of myocardial fibrosis evaluated at CCT with EAM (electro-anatomical mapping).


      We prospectively enrolled a consecutive cohort of patients with clinical indication to EAM before radiofrequency catheter ablation (RFCA) of refractory ventricular tachycardia (VT) and an absolute contraindication to cardiac magnetic resonance. All patients underwent per protocol CCT for myocardial fibrosis and coronary anatomy evaluation. Diagnostic performance was assessed for myocardial fibrosis evaluation with CCT vs EAM. Live integration feasibility of CCT vs EAM was evaluated for every patients.


      A total of 19 patients were included in the present study with 323 myocardial segments analyzed for myocardial fibrosis at CCT. In all patients CCT data were successfully integrated with EAM during RFCA procedure. All patients had myocardial fibrosis correctly identified at CCT vs EAM on a per-patients basis. A diagnostic accuracy on a per-segment basis of 94.1% for detection of any type of myocardial fibrosis at CCT vs EAM was recorded.


      CCT identification of myocardial fibrosis is feasible and accurate vs EAM in a very selected high risk patients with clinical indication to RFCA of VT and contraindication to CMR.

      Graphical abstract


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      Full access to the journal is a member benefit for SCCT Members, Login via the SCCT website to access all journal content.


      Subscribe to Journal of Cardiovascular Computed Tomography
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • von Knobelsdorff-Brenkenhoff F.
        • Schulz-Menger J.
        Role of cardiovascular magnetic resonance in the guidelines of the European Society of Cardiology.
        J Cardiovasc Magn Reson. 2016; 18: 6
        • Mavrogeni S.
        • Petrou E.
        • Kolovou G.
        • Theodorakis G.
        • Iliodromitis E.
        Prediction of ventricular arrhythmias using cardiovascular magnetic resonance.
        Eur Heart J Cardiovasc Imag. 2013 Jun; 14 (Epub 2013 Jan 16): 518-525
        • Andreini D.
        • Dello Russo A.
        • Pontone G.
        • et al.
        CMR for identifying the substrate of ventricular arrhythmia in patients with normal echocardiography.
        JACC Cardiovasc Imag. 2020 Feb; 13 (Epub 2019 Jul 17. PMID: 31326488): 410-421
        • Dukkipati S.R.
        • Choudry S.
        • Koruth J.S.
        • Miller M.A.
        • Whang W.
        • Reddy V.Y.
        Catheter ablation of ventricular tachycardia in structurally normal hearts: indications, strategies, and outcomes-Part I.
        J Am Coll Cardiol. 2017 Dec 12; 70: 2909-2923
        • Tian J.
        • Jeudy J.
        • Smith M.F.
        • et al.
        Three-dimensional contrast-enhanced multidetector CT for anatomic, dynamic, and perfusion characterization of abnormal myocardium to guide ventricular tachycardia ablations.
        Circ Arrhythm Electrophysiol. 2010; 3: 496-504
        • Komatsu Y.
        • Sacher F.
        • Cochet H.
        • Jaïs P.
        Multimodality imaging to improve the safety and efficacy of epicardial ablation of scar-related ventricular tachycardia.
        J Cardiovasc Electrophysiol. 2013; 24: 1426-1427
        • Maffei E.
        • Messalli G.
        • Martini C.
        • et al.
        Left and right ventricle assessment with Cardiac CT: validation study vs. Cardiac MR.
        Eur Radiol. 2012; 22: 1041-1049
        • Pickett C.A.
        • Cheezum M.K.
        • Kassop D.
        • Villines T.C.
        • Hulten E.A.
        Accuracy of cardiac CT, radionucleotide and invasive ventriculography, two- and three-dimensional echocardiography, and SPECT for left and right ventricular ejection fraction compared with cardiac MRI: a meta-analysis.
        Eur Heart J Cardiovasc Imag. 2015; 16: 848-852
        • le Polain de Waroux J.B.
        • Pouleur A.C.
        • Goffinet C.
        • Pasquet A.
        • Vanoverschelde J.L.
        • Gerber B.L.
        Combined coronary and late-enhanced multidetector-computed tomography for delineation of the etiology of left ventricular dysfunction: comparison with coronary angiography and contrast-enhanced cardiac magnetic resonance imaging.
        Eur Heart J. 2008 Oct; 29: 2544-2551
        • Sato A.
        • Nozato T.
        • Hikita H.
        • Akiyama D.
        • et al.
        Prognostic value of myocardial contrast delayed enhancement with 64-slice multidetector computed tomography after acute myocardial infarction.
        J Am Coll Cardiol. 2012 Feb 21; 59: 730-738
        • Esposito A.
        • Palmisano A.
        • Antunes S.
        • et al.
        Cardiac CT with delayed enhancement in the characterization of ventricular tachycardia structural substrate: relationship between CT-segmented scar and electro-anatomic mapping.
        JACC Cardiovasc Imag. 2016 Jul; 9 (Epub 2016 Feb 17. PMID: 26897692): 822-832
        • Carbucicchio C.
        • Andreini D.
        • Piperno G.
        • et al.
        Stereotactic radioablation for the treatment of ventricular tachycardia: preliminary data and insights from the STRA-MI-VT phase Ib/II study.
        J Intervent Card Electrophysiol. 2021 Oct 5; : 1-13
        • Conte E.
        • Mushtaq S.
        • Carbucicchio C.
        • et al.
        State of the art paper: cardiovascular CT for planning ventricular tachycardia ablation procedures.
        JCCT. 2021; (in press)
        • Njeim M.
        • Desjardins B.
        • Bogun F.
        Multimodality imaging for guiding EP ablation procedures.
        JACC Cardiovasc Imag. 2016; 9: 873-886