Integration of Three-Dimensional Scar Maps for Ventricular Tachycardia Ablation With Positron Emission Tomography-Computed Tomography

Integration of Three-Dimensional Scar Maps for Ventricular Tachycardia Ablation With Positron Emission Tomography/Computed Tomography Timm Dickfeld, Peng Lei, Vasken Dilsizian, Jean Jeudy, Jun Dong, Apostolos Voudouris, Robert Peters, Magdi Saba, Raj Shekhar, Stephen Shorofsky Substrate-guided ablation of nonidiopathic ventricular tachycardia requires a detailed knowledge of the ventricular scar and border zone. Among patients with internal cardiac defibrillators who were scheduled to undergo ventricular tachycardia ablation, positron emission tomography (PET)/computed tomography (CT)-derived metabolic scar maps were used to characterize myocardial scar using a 17-segment analysis and surface reconstruction. The use of PET/CT to define scar size, location, and border zone accurately predicted high-resolution voltage map findings. However, PET/CT scar maps also identified metabolically active channels within the myocardial scar as well as nontransmural scar that were not detected by voltage mapping alone. This is the first study to integrate 3D PET/CT-derived scar maps in the electrophysiology laboratory and demonstrate that 3D metabolic scar maps can achieve supplemental substrate characterization for ventricular tachycardia ablations not available from endocardial voltage maps alone.