Developing an individualized approach for catheter ablation of ventricular tachycardia based on noninvasive cardiac imaging

Despite the development of modern diagnostic technology and intraoperative navigation, catheter ablation of ventricular tachycardia in patients with coronary heart disease remains difficult. This procedure is challenging because of the electrical heterogeneity of the damaged myocardium, which leads to the emergence of reentry cycles. The clinical case that is presented is part of a study aimed at finding a personalized approach to VT ablation. A 53 year old man with coronary heart disease, post-infarction cardiosclerosis, stenting of the right coronary artery and paroxysmal ventricular tachycardia was admitted to the cardiac surgery department with arrhythmias. Recently, this patient had experienced paroxysms of arrhythmias more frequently, up to several times a month, despite receiving antiarrhythmic therapy. Upon admission, the patient complained of a rapid heartbeat, weakness and discomfort in the chest area. The patient’s current drug therapy included betalok, cardiomagnyl and rosuvastatin. Due to his condition, the patient was asked to participate in a study with the aim of developing a personalized approach to the ablation of ventricular cardiac arrhythmias. After the patient agreed to be included in the study, he underwent a series of tests including single-photon emission computed tomography of the myocardium with perfusion and non-neutropic radiopharmaceuticals and magnetic resonance imaging of the heart with contrast. Based on these tests a targeted ablation was performed which relieved the tachycardia, the impossibility of subsequent induction and the homogenization of the substrate until the disappearance of pathological symptoms. The presented clinical case demonstrates the possibility of using non-invasive imaging methods to develop a personalized approach to VT ablation in patients with coronary artery disease. However, the diagnostic accuracy, prognostic ability and feasibility of using these methods require further study. Received 8 April 2020. Revised 22 April 2020. Accepted 24 April 2020. Funding: The work is supported by a financial grant of the Russian Science Foundation (project No. 17-75-20118). Conflict of interest: Authors declare no conflict of interest. Author contributions Drafting the article: A.B. Romanov, S.M. Minin, N.A. Nikitin Literature review: A.G. Filippenko, E.A. Morzhanaev, I.S. Peregudov Illustrations: A.B. Romanov, S.V. Shayakhmetova, S.M. Minin, N.A. Nikitin, V.V. Shabanov Critical revision of the article: A.B. Romanov, С.В. Шаяхметова, S.M. Minin, N.A. Nikitin, I.L. Mikheenko, V.V. Shabanov, D.V. Losik Surgical treatment: A.B. Romanov Final approval of the version to be published: A.B. Romanov, S.M. Minin, S.V. Shayakhmetova, N.A. Nikitin, A.G. Filippenko, I.L. Mikheenko, E.A. Morzhanaev, I.S. Peregudov, D.V. Losik, V.V. Shabanov