Abstract 11805: CT-based Virtual Heart and 12-lead ECG-based Automated VT Localization Method Identify Ablation Targets in a Patient Undergoing Intramural Ablation—A Case Study

IntroductionInfusion-needle catheter ablation of VT within deep intramural substrate requires accurate identification of appropriate targets. We have developed an automated method for localizing VTs in real time using 12-lead ECG and CT, and have developed CT-based 3D virtual-heart technology incorporating intramyocardial fat to predict ablation targets.HypothesisWe hypothesized that 2 new technologies, automated VT localization and CT-based virtual-heart can both help localize intramural ablation targets in patients with infarct-related VT.MethodsIn a post-infarction patient with prior unsuccessful VT ablation, intramural needle ablation was performed. VT termination sites were compared to exits predicted by automated VT localization and to the VT circuits predicted by simulations with CT-based virtual-heart. VT-exit localization was conducted during the procedure; the virtual heart simulations were conducted retrospectively.ResultsOf 4 VTs induced in the patient, 3 were successfully terminated with the needle procedure. VTs A and C terminated with ablation in the mid-inferoseptal region, and VT B at the mid posterior scar margin (Fig1. a, d, g). The automated VT localization method predicted VT A would exit at the mid inferoseptal region within 6.3mm of the site of termination with needle ablation (Fig1. c); VTs B & C were terminated within the middle of the scar at sites proximal to the scar exit site. The predicted exit sites were close to the termination sites (Fig1. f, i) (accuracy could not be precisely quantitated because VT was terminated at a mid-diastolic site). The CT-based virtual heart predicted 3 VT circuits (Fig1. b, e, h), one primarily endocardial (VT B) and two intramural circuits (VTs A & C), which also closely matched clinical ablation targets.ConclusionsBoth methodologies reach a consensus in localizing intramural ablation targets and may prove valuable in directing deep myocardial ablation procedures.