3D CMR–guided ventricular tachycardia ablation
DOI:
https://doi.org/10.53903/01212095.463Keywords:
Ventricular Tachycardia, Cardiac Magnetic Resonance Imaging, Catheter Ablation, Myocardial Fibrosis, ElectrophysiologyAbstract
Sustained monomorphic ventricular tachycardia (VT) is a potentially life-threatening arrhythmia, particularly prevalent in patients with structural heart disease and myocardial scarring, where reentry mechanisms predominate. Catheter ablation is a key therapeutic strategy; however, its effectiveness depends on accurate identification of the arrhythmogenic substrate. Cardiac magnetic resonance imaging (CMRI) with three-dimensional delayed enhancement (3D-DE) allows for a detailed anatomical characterization of myocardial fibrosis and borderzone channels. We present the case of a 52-year-old man with prior myocarditis, hypertension, and type 2 diabetes mellitus, carrying an implantable cardioverter-defibrillator, who was admitted due to multiple appropriate
shocks. A 3T CMR study with 3D LGE and ADAS 3D analysis identified intramural septal fibrosis with biventricular border zone corridors. Electro-anatomical mapping confirmed low-voltage areas consistent with the three-dimensional reconstruction. Two VTs with different morphologies were induced, and their critical isthmuses were localized in right and left septal regions guided by CMRderived anatomical information. Targeted ablation resulted in termination of both arrhythmias, without complications or recurrences during follow-up. This case illustrates the clinical value of image–electrophysiology integration, highlighting how three-dimensional CMR substrate analysis may optimize ablation strategy in complex scar-related ventricular arrhythmias.
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