Integration of Functional Mapping and Image-Guided Structural Information in Ventricular Tachycardia Ablation - Sense2 Mapping

Background Functional substrate mapping techniques are increasingly utilised in clinical practice but can involve protracted mapping and procedure time. Objective We incorporated magnetic resonance imaging (MRI) and computed tomography (CT) derived ventricular scar data into the functional mapping workflow to assess the efficacy and outcome compared to conventional ablation strategies. Methods In this prospective multicenter registry, 166 patients with post-infarct Ventricular Tachycardia (VT) were enrolled into a prospective propensity matched registry. Cardiac MRI/CT scans were performed to target focused regions for functional mapping and ablation (Sense2). This was compared to a group that underwent mapping without image guidance (Sense) and a group that underwent activation/entrainment or substrate guided mapping and ablation without functional mapping or image guidance (Institutional). Results In the Sense2 group (145.8±28.7 mins), the mean procedural time was significantly shorter compared to the Sense group (171.0±51.1 mins) and Institutional group (221.4±73.9 mins), (p<0.0001). Similarly, mapping time was shorter (25.4 ± 7.3mins) compared to Sense (47.2 ± 8.9). Ablation time was significantly reduced in the Sense2 (18.1±11.6 mins) compared to the Sense (21.6±12.7 mins) and to the Institutional (25.9±13.9 mins) (p=0.006). Patients in the Sense2 and Sense had higher freedom from VT (p<0.001 for both) and improved survival (p<0.05 for both) compared to Institutional group. Conclusion Sense2, integrating imaging with functional mapping, reduced the procedural times by enabling focused substrate maps to be performed and improved outcomes in terms of VT freedom compared to Institutional ablation. The improved survival requires corroborating with multi- centre randomized trials.