Cardiovascular diseases are the leading cause of death in Europe and sudden cardiac death (SCD) accounts for a significant proportion. SCDs are mostly due to ventricular arrhythmias such as Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF). Most patients with VT are people who have already suffered a myocardial infarction. Patients have the problem of recurrent arrhythmias, and the degradation of their quality of life due to Implantable cardioverter defibrillator (ICD) shocks.
Interventional cardiologists face difficulties in treating these patients, as target identification is difficult, and there is a need to improve the low success rate in treating complex cardiac tachyarrhythmias, such as ventricular tachycardia (VT). Catheter ablation is the gold standard procedure for preventing tachyarrhythmias in patients at risk of VT.
However, area identification is a key issue and most of the procedure time is spent identifying ablation targets, currently achieved by intracardiac insertion of a mapping catheter. The problem is the preoperative identification of arrhythmogenic sites within the myocardial scar tissue from medical images to guide cardiologists during the procedure.
Ventricular tachycardia ablation is still a very challenging procedure. Currently, targets’ identification relies on an invasive intracardiac mapping procedure. A specific and expensive catheter is introduced in the vascular system to access the heart. This catheter is moved manually across the entire cardiac chamber so that electrodes can record the electrical activity (electrograms), looking for abnormalities.
This is cumbersome, and only superficial endocardial abnormalities are detected. Therefore about 80% of the procedure time is devoted to this diagnostic step, which is not completely standardised and dependent on operator experience for the interpretation of complex electrograms. The inaccurate and incomplete identification of ablation targets probably account for some of the procedural failures (40-50%) and subsequent repeated interventions. Finally, cost-effectiveness is questionable, with a recently reported QALY of 161 448€ compared to anti-arrhythmic drugs.